甲状腺转录因子-1、天冬氨酸蛋白酶A、p40和p63在228例非小细胞肺癌患者中的病理分型诊断价值及临床病理特征分析

The Value of TTF-1, NapsinA, p40 and p63 in the Pathological Classification and Diagnosis and Analysis of Clinicopathological Characteristics in 228 Cases of Non-Small Cell Lung Cancer Patients

摘要: 目的：探讨甲状腺转录因子-1 (TTF-1)、天冬氨酸蛋白酶A (NapsinA)、p40和p63的表达在非小细胞肺癌中的病理分型诊断价值，并分析其与患者临床病理特征的关系。方法：选取228例非小细胞肺癌患者的癌组织标本，收集患者的临床资料，通过免疫组化法检测TTF-1、NapsinA、p40和p63蛋白的表达，分析4个蛋白表达与患者临床病理特征的关系，并采用受试者工作特征(ROC)曲线评价其表达阳性对肺癌病理分型的诊断价值，计算其曲线下面积(AUC)，分析其阳性表达时分型诊断的敏感性和特异性。结果：本研究纳入228例非小细胞肺癌患者，其中腺癌123例，鳞癌105例，中位年龄61岁，男性占78.5%。TTF-1和NapsinA阳性表达与患者的性别、吸烟史、肿瘤大小有关(均p < 0.05)，而与年龄、临床分期、淋巴结转移和远处转移等无关(均p > 0.05)。p40和p63阳性表达与年龄、吸烟史、肿瘤大小、临床分期、淋巴结转移和远处转移等无关(均p > 0.05)。TTF-1和NapsinA阳性诊断肺腺癌的敏感性、特异性分别为78.0%、88.6% (AUC = 0.833, p < 0.05)和76.4%、96.2% (AUC = 0.863, p < 0.05)。p40和p63阳性诊断肺鳞癌的敏感性、特异性分别为71.0%、94.3% (AUC = 0.876, p < 0.05)和65.7%、91.1% (AUC = 0.784, p < 0.05)。结论：TTF-1和NapsinA均对肺腺癌具有一定的诊断价值，其中NapsinA的诊断价值较高；p40和p63对肺鳞癌具有一定的诊断价值，其中p40的诊断价值较高。

Abstract: Objective: To investigate the value of the expression of TTF-1, NapsinA, p40 and p63 in the pathological classification and diagnosis of non-small cell lung cancer (NSCLC), and to analyze the relationship between them and the clinicopathological characteristics of patients. Methods: Cancer tissue specimens of 228 cases of non-small cell lung cancer patients were selected, and their clinical data were collected. The protein expression of TTF-1, NapsinA, p40 and p63 was detected by immunohistochemistry, and the relationship between them and the clinicopathological characteristics of patients was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of positive expression for pathological classification of lung cancer. The area under curve (AUC) was calculated, and the sensitivity and specificity of its positive expression for classification diagnosis were analyzed. Results: 228 cases of NSCLC were included in this study, including 123 cases of adenocarcinoma and 105 cases of squamous cell carcinoma. The median age was 61 years old, and 78.5% of them were male. The positive expression of TTF-1 and NapsinA was correlated with gender, smoking history and tumor size (p < 0.05), but was not related to age, clinical stage, lymph node metastasis and distant metastasis (p > 0.05). The positive expression of p40 and p63 was not related to age, smoking history, tumor size, clinical stage, lymph node metastasis and distant metastasis (p > 0.05). The sensitivity and specificity of TTF-1 and NapsinA were 78.0%, 88.6% (AUC = 0.833, p < 0.05) and 76.4%, 96.2% (AUC = 0.863, p < 0.05), respectively. The sensitivity and specificity of p40 and p63 were 71.0%, 94.3% (AUC = 0.876, p < 0.05) and 65.7%, 91.1% (AUC = 0.784, p < 0.05), respectively. Conclusions: TTF-1 and NapsinA have certain diagnostic value for lung adenocarcinoma, and NapsinA has higher diagnostic value. P40 and p63 have a certain value in the diagnosis of lung squamous cell carcinoma, of which p40 has a higher value.