The Molecular Biology Of Rh-endostatin Plus Chemotherapy As Adjuvant Treatment For Non-small Lung Cancer

Objective:Non-small cell lung cancer (NSCLC) accounts for about 80% of lung cancer, surgical resection is an important treatment for NSCLC, complete resection of the 5-year survival rates were: phase IA 67%,phaseIB 57%,phaseIIA 55%,phaseIIB 39%,phaseIIIA 32%。Except phaseI, the standard treatment of non-small cell lung cance that patients receive surgical resection is adjuvant chemotherapy,in order to improve survival rates, but there is still a high recurrence rate and mortality. In recent years ,with the development of molecular biology, adjuvant targeted therapy after surgical resection become more and more attention,adjuvant chemotherapy combined with endostar targeted therapy enter the adjuvant therapy areas of non-small cell lung cancer that patients receive surgical resection,and now on going,we hope to find the most appropriate people that suit for adjuvant chemotherapy combined with endostar targeted therapy after postoperative, for the sake of playing the largest role of endostar and making full use of health resources,there is the positive clinical significance of improving the survival rate and decreasing the recurrence rate.More and more people concern that gene expression in NSCLC will impact the efficacy of treatment. This study attempts to find biological markers that can predict the efficacy of treatment- NP (vinorelbine + cisplatin) combined with endostar from the molecular biology level, such as VEGF(vascular endouthelial growth factor),BRCA1,ERCC1,β-tubulin,CD3 expression,it is a reference to clinical for adjuvant chemotherapy combined with endostar targeted therapy after postoperative.Methods:36 cases of non-small cell lung cancer patients who will meet the study criteria were divided into two groups- chemotherapy combined with endostar and chemotherapy only,then made these paraffins to 6μm thick sections,used immunohistochemistry method to detect the expression of VEGF,BRCA1,ERCC1,β-tubulin,CD3. Adjuvant chemotherapy combined with endostar 4 cycles,1 cycles contains 21days. The chemotherapy scheme is NP(vinorelbine + cisplatin).we censused the disease-free survival (DFS) of the two group of patients before the end of the study,combined with the detect results of molecular biological ,seted up statistical correlation.Results:1.In this study, the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(18month vs14month),P=0.001,P<0.05。2. In 36 patients, VEGF expressing: the group of NP combined with endosta-low expression(-～+)6 cases,high expression(++～+++)12 cases; the group of NP chemotherapy only- low expression(-～+)6 cases,high expression(++～+++)12 cases. The statistical analysis show that low expression of VEGF: the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(19month vs12month),P=0.042,P<0.05; high expression of VEGF: the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(18month vs14month),P=0.022,P<0.05.3. In 36 patients, BRCA1 expressing: the group of NP combined with endosta-low expression(-～+)4 cases,high expression(++～+++)14cases; the group of NP chemotherapy only- low expression(-～+)4 cases,high expression(++～+++)14cases. The statistical analysis show that low expression of BRCA1: the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(15month vs 8month),P=0.014,P<0.05; high expression of BRCA1:the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(18month vs17month),P=0.007,P<0.05.4. In 36 patients, ERCC1 expressing: the group of NP combined with endosta-low expression(-～+)7 cases,high expression(++～+++)11cases; the group of NP chemotherapy only- low expression(-～+)5cases,high expression(++～+++)13cases. The statistical analysis show that low expression of ERCC1: There is no significant difference between the two group in the median DFS(15month vs14month),P=0.31,P>0.05; high expression of ERCC1:the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(19month vs13month),P=0.001,P<0.05.5. In 36 patients,β-tubulin expressing: the group of NP combined with endosta-low expression(-～+)8cases,high expression(++～+++)10cases; the group of NP chemotherapy only- low expression(-～+)8cases,high expression(++～+++) 10 cases. The statistical analysis show that low expression ofβ-tubulin: there is no significant difference between the two group in the median DFS(18month vs14month),P=0.209,P>0.05; high expression ofβ-tubulin:the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(19month vs12month),P=0.001,P<0.05.6. In 36 patients, CD3 expressing: the group of NP combined with endosta-low expression(-～+)18cases; the group of NP chemotherapy only- low expression(-～+)18cases. The statistical analysis show that low expression of CD3: the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only(18month vs14month),P=0.001,P<0.05.Conclusion:1. The adjuvant therapy of NSCLC that afte postoperative, the group of NP combined with endosta is better than the group of NP chemotherapy only, the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only.2. Whether VEGF,BRCA1is high expression or low expression, the DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only;ERCC1 is low expression ,there is no significant difference between the two group in the median DFS; ERCC1 is high expression, the median DFS in the group of NP combined with endosta is significantly longer than the group of chemotherapy only; low expression ofβ-tubulin there is no significant difference between the two group in DFS; high expression ofβ-tubulin, the DFS in the group of NP combined with endosta is significantly longer; low expression of CD3, the DFS in the group of NP combined with endosta is significantly longer.3. According to the level of VEGF, BRCA1, ERCC1,β-tubulin and CD3 expression ,guide the choice of adjuvant therapy in NSCLC that afte postoperative, make the individual therapy to become reality.