| [Objective] To summarize and review the clinic characteristic of surgical resection of IIIA on-small cell lung cancer, the clinic effect of preoperative neoadjuvant chemotherapy, the change law of Survivin,P53 and Bcl-2 before and after operation. Explore the clinical and molecular features of preoperative neoadjuvant chemotherapy and postoperative chemotherapy for IIIA NSCLC. To provide the basis for establishing individual pattern of IIIA NSCLC preoperative and postoperative adjuvant treatment, the theory basis for developing forward-looking individual treatment research of IIIA NSCLC patients.[Method] From Jan.2001 to Dec.2006, the patients of Chinese PLA General Hospital and the Great Hospital of People's Armed Police Forces received surgery treatment after two period's preoperative neoadjuvant chemotherapy. All patients received nothing treatment before neoadjuvant chemotherapy. We followed the III non-small cell lung cancer patients with data integrity and analyzed the characters of clinic, pathology, treatment and survival rule. Use immunohistochemistry to examine preoperative percutaneous biopsy under CT guided of all patients or bronchscope biopsy specimens and the expression of Survivin, P53, and Bcl-2 protein of resectable tumour sample. Adopt SPSS16.0 software to analyze the single factor and multiple factors of patients'clinic character, treatment character, curative effect and survival rule. And analyze the expression, variety and curative effect of preoperative and postoperative Survivin, P53,and Bcl-2 protein [Result] In the whole 85 patients exclude 3 cases disease progressed 82 cases received surgery treatment after change chemotherapy regime and integrate local radiotherapy. In imaging response no patients obtained complete remission,50 partial remission patients,58.8%;32 stable patients,37.6%;3 disease progressed patients,3.6%.Postoperative pathological response showed that 34 patients'pathology change effective with efficiency rate41.5%; 19 pathology regressions, regression rate 23.3%, within Nl 15 cases,18.3% and NO 4 cases. During postoperative follow-up 36.4-93.1 months and median follow-up 58.2 months,49 cases (28.8%) of all 85 cases died,3 surgical cases died after 1 month,3.7%. Median survival time 22.1 months,1,2,3 year overall survival rate were 67.5%,38.9% and 27.4% respectively. Median survival time 31.3 month of 55 cases complete resection,1,2,3 year overall survival rate were 71.2%,52.5% and 38.6% respectively.The survival rate of 16 cases palliative resection was 12.4 month. Postoperative multiple factors found that pathology response,pathology regressions,surgery method and postoperative chemotherapy are the single factor to affect prognosis.The expression rates of Survivin, P53, Bcl-2 protein masculine in Preoperative biopsy specimens were 65.88%,78.82% and 71.76% respectively. The expression rates of Survivin, P53, Bcl-2 protein feminine expression in preoperative biopsy specimens were 66.67%,77.78% and 66.67% respectively. The efficiency rates of masculine group were 31.25%,23.88% and 29.50% respectively. The expression rates of masculine and feminine in Survivin, P53 protein expression group were 22.41% and 100%. The pathology efficiency rates of masculine and feminine in Survivin, Bcl-2 protein expression group were 23.64% and 93.33%.The pathology efficiency rates of masculine and feminine in P53 and Bcl-2 were 33.96% and 90.91%. The pathology efficiency rates of masculine and feminine in Survivin,P53,Bcl-2 were 6.09%,100%.There were 39 cases,45 cases and 51 cases expression down-regulation of Survivin,P53,Bcl-2 protein after chemotherapy. There were obvious differences in Histological effectiveness between ascending group or no changing group and down-regulation group of each protein.There were markedly discrepancies in median survival time between postoperative chemotherapy and non-postoperative chemotherapy patients in three down-regulation protein groups, however little difference between postoperative chemotherapy and non-postoperative chemotherapy patients of ascending group and no changing group.[Conclusion] Not all patient of IIIA NSCLC could benefit from preoperative neoadjuvant chemotherapy with platinum regimen chemotherapy. There were no obvious relativity between imaging response and pathological response of preoperative adjuvant chemotherapy, so it couldn't be estimate whether preoperative adjuvant chemotherapy are effective by imaging response. Pathological response, pathological regression, surgical method and postoperative chemotherapy of IIIA NSCLC patients received preoperative adjuvant chemotherapy were single prognosis factors. There were obvious differences in histology effective rates between P53 protein masculine group and feminine group. We don't know whether P53 protein could express preoperative chemotherapy index, but the protein expression level couldn't forecast patients'reaction for preoperative chemotherapy. There were no obvious differences in histology efficiency rate between masculine and feminine expression group of Survivin, Bcl-2 protein, so whether the two proteins could mark as index to forecast preoperative chemotherapy response, and the strong masculine gender of two proteins could judge patients'insensitive for preoperative neoadjuvant chemotherapy. Both expressions of Survivin, P53 and Bcl-2 could be qua standard for forecasting preoperative neoadjuvant chemotherapy. The expression level changing of postoperative Survivin, P53, and Bcl-2 could judge treatment effect of postoperative chemotherapy and patients'prognosis.
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