Study On Nm23 Expression And Targeted Reversal In NSCLS And The Effect Of PET/CT On Nm23 Expression In Nsclc Staging And Radiotherapy Planning

Objective:To study and explore the expression,clinical significance and correlation of nm23 gene and other genes（EGFR,VEGF）in NSCLC,so as to provide more reference information for the selection of the most effective drugs for the clinical treatment of NSCLC.Targeting to reverse the effect of nm23 gene on radiotherapy sensitivity of non-small cell lung cancer and explore its possible mechanism.To investigate the effect of PET/CT and enhanced CT on nm23 expression in non-small cell lung cancer staging and radiotherapy planning.Methods:1)Tumor tissue samples from 180 patients with non-small cell lung cancer with positive expression of nm23 were selected and classified as research group.Para-carcinoma normal lung tissues from 53 non-small cell carcinoma specimens in the above study group were selected as the control group.The expression of nm23,EGFR and VEGF genes in the two groups was detected and the differences were compared.A retrospective analysis was performed on the 180 patients mentioned above to analyze the differences and correlations of the expressions of nm23,EGFR and VEGF in different genders,pathological types,differentiation degrees,lymph node metastasis and tumor stages.2)The expression levels of nm23 mRNA in different non-small cell lung cancer cell lines A549 and H1299 were detected by real-time fluorescence PCR.The control group was irradiated with cell line A549,while the experimental group was irradiated with overexpressed nm23 recombinant plasmid A549.The colony formation of each group was detected by cloning experiments.The expression of nm23 mRNA in each group was detected by real-time fluorescence PCR and analyzed statistically.Western Blot was used to detect the expression of PI3K and AKT in the two groups and analyze the differences in their expression.3)213 patients with non-small cell lung cancer（NSCLC）with nm23 expression were selected as the research objects.According to the different methods of image examination,the patients were divided into PET/CT group and enhanced CT group.In the PET/CT group,SUVmax and GTVPET/CT of the nm23 group with strong positive expression（>++）and positive expression of nm23（≤++）were compared.The changes in tumor staging,the size of the target area delineated,and the exposure dose to the target area of organs at risk were observed and compared between the PET/CT group and the enhanced CT group,to evaluate the differences in the delineation of the radiotherapy target area and the impact on the staging and radiotherapy plan.Results:1)Expression of EGFR,VEGF and nm23 in non-small cell lung cancer and adjacent normal lung tissues:the positive rates of EGFR and VEGF in the non-small cell lung cancer group were significantly higher than the control group,while the positive rates of nm23 were significantly lower than the control group,with statistically significant differences.The relationship between the expression of EGFR,VEGF and nm23 and the clinicopathological characteristics of NSCLC:（1）in terms of gender and tumor differentiation degree,there were no statistically significant differences in the positive expression of EGFR,VEGF and nm23.（2）pathological types:the positive EGFR expression rate of adenocarcinoma group was higher than that of squamous cell carcinoma group;VEGF and nm23 positive expression rate in there was no statistically significant difference on adenocarcinoma and squamous cell carcinomas（3）:tumor staging EGFR positive expression rate in tumor stage forⅢ-Ⅳgroup is higher than the tumor stage forⅠ-Ⅱgroup,the difference was statistically significant;EGFR and nm23 inⅠ-Ⅱperiod andⅢ-there was no statistically significant differenceⅣmidterm.（4）lymph node metastasis:the positive expression rates of EGFR and VEGF in the lymph node metastasis group were higher than those in the non-lymph node metastasis group,with statistically significant differences.The positive expression rate of nm23 in the group with lymph node metastasis was lower than that in the group without lymph node metastasis.（5）The expression level of nm23 mRNA in A549 and H1299 non-small cell cancer cell lines was statistically significant,and the expression level of nm23 in A549non-small cell lung cancer cell lines was lower.The difference of MLD value and SF2value between the experimental group and the control group was statistically significant.There was a statistically significant difference in cell survival between the experimental group and the control group under different radiotherapy doses.The difference of nm23mRNA expression level between the experimental group and the control group was statistically significant under each radiotherapy dose.There were statistically significant differences in the relative expression levels of PI3K and AKT between the experimental group and the control group at each radiotherapy dose.3)In the PET/CT group both SUVmax and GTV_PET/CT in the strongly positive nm23 group were lower than those in the positive nm23 group.Compared with the two groups of enhanced CT group the PET/CT group had statistically significant differences in the stage change of non-small cell carcinoma,gross target area volume（GTV）,and radiotherapy exposure to organs at risk.3)Compared with the two groups of enhanced CT,PET/CT group showed statistically significant differences in the staging change of non-small cell carcinoma,gross target area volume（GTV）,and exposure to organs at risk when the target area was delineated.Conclusion:1)Immunohistochemical detection of nm23,EGFR and VEGF is helpful for clinical understanding of the degree of lesions in patients with non-small cell lung cancer,providing more valuable information for the formulation of treatment plans and the selection of appropriate drugs.2)targeted reversal of nm23 can enhance the radiotherapy sensitivity of non-small cell lung cancer,which is related to the PI3K/AKT/mTOR signaling pathway.3)Understanding the expression of nm23 gene in non-small cell lung cancer can provide more valuable information for the target of radiotherapy.In the radiotherapy of non-small cell lung cancer,PET/CT helps to improve the accuracy of target delineation,and at the same time can better protect the surrounding normal tissues and organs,so as to benefit the patients.