| Objective: Lung cancer is one of the common malignant tumour, and its incidency has been increasing year by year. Approximately 70% of lung cancer patients was in late strage when he is diagnosised. Despite novel therapies in lung cancer treatment, the 5-year survival rate still remains less than 15%. In order to improve the five-year survival ,it is important for us to diagnose the lung cancer and give treatment early. And now, screening concepts for early diagnosis of lung cancer is still based on conventional sputum cytology and chest radiography,and its sensitivity is indifference, so the early diagnosis rate of lung cancer is still at a low level. The aim of this study is to discuss relationship between Survivin, P53, Bcl-2 in sputum and the biological behavior of lung cancer, so that we can find a new approache ,which is the safest, non-invasive, least costly and easily accepted by patients, for the detection of cancer, and it will be used widely in the early diagnosis of lung cacer and in screening of high-risk individuals. Methods: The levels of Survivin ,P53 and Bcl-2 in sputum were detected in 40 patients with lung cancer ,15 patients with pulmonary benign disease and 9 healthy volunteers by flow cytometry(FCM). We have compared the relationships between the levels of the three markers in lung cancer , pulmonary benign disease and healthy volunteers. In the lung cancer patients ,we observed the relationships between the levels of Survivin ,P53 , Bcl-2 in sputum and histotype, clinic stage, sex, or age smoking history. At the same time, we compared the levels of Survivin ,P53 , Bcl-2 in sputum with the cases with lymph node metastasis and the cases with non-lymph node metastasis. Results: 1.Mean level of Survivin in sputum was significantly elevated in lung cancer samples compared with benign diseases and volunteers (1.155±0.264 vs 0.914±0.197,1.155±0.264 vs 0.878±0.169, P<0.05), but the difference of pulmonary benign diseases and healthy volunteers was not statistical significance (P>0.05). The level of Survivin in sputum was little higher in small cell lung cancer(SCLC) than that of in non-small lung cancer(NSCLC) (1.257±0.321 vs 1.146±0.264), the level of Survivin in sputum was little higher in adenocarcinoma than that of in squamous cell carcinoma (1.189±0.290 vs 1.119±0.250), but the differences were not statistical significance (P>0.05). The study indicated that there was no relationship between Survivin protein expression and clinical stage, sex, age, smoking history, or lymph node metastasis(P>0.05). 2. Mean level of Bcl-2 in sputum was significantly elevated in lung cancer samples compared with benign diseases and volunteers (1.182±0.199 vs 0.950±0.179,1.182±0.199 vs0.914±0.335, P<0.05), but the difference of pulmonary benign diseases and healthy volunteers was not statistical significance (P>0.05). The level of Bcl-2 in sputum was little higher in SCLC than that of in NSCLC (1.207±0.110 vs 1.169±0.197), the level of Bcl-2 in sputum was little higher in squamous cell carcinoma than that of in adenocarcinoma (1.214±0.201 vs 1.114±0.193), but the differences were not statistical significance (P>0.05). The study indicated that there was no relationship between Bcl-2 protein expression and clinical stage, sex, age, or smoking history (P>0.05).However, the level of Bcl-2 in sputum in cases with non-lymph node metastasis was higher than that of in lymph node metastasis (1.233±0.200 vs 1.101±0.174, P<0.05). 3. Mean level of P53 protein in sputum was significantly elevated in lung cancer samples compared with benign diseases and volunteers (1.270±0.263 vs 1.043±0.350,1.270±0.263 vs 0.909±0.154, P<0.05), but the difference of pulmonary benign diseases and healthy volunteers was not statistical significance (P>0.05). The level of P53 protein in sputum was little higher in SCLC than that of in NSCLC (1.347±0.133 vs 1.263±0.271), the level of P53 in sputum was little higher in adenocarcinoma than that of in squamous cell carcinoma (1.285±0.226 vs 1.249±0.301), but the differences were not statistical significance (P>0.05). The study indicated that there was no relationship between P53 protein expression and clinical stage, sex, age, or lymph node metastasis(P>0.05).However, there wasstatistical significance between the group who smoked more than 20 packet a year and those who smoked less than 20 packet a year(1.354±0.250 vs 1.191±0.177, P<0.05). 4. The level of Survivin and P53 protein in sputum was little higher in peripheral lung cancer than that of in central type lung cancer(1.177±0.303 vs 1.150±0.225,1.268±0.311 vs 1.237±0.210 ), but the level of Bcl-2 in sputum was little higher in central type lung cancer(1.148±0.163)than that of in peripheral lung cancer(1.131±0.226).All of them were not statistical significance (P>0.05). 5.The level of Survivin in sputum was correlated to the level of P53 or Bcl-2 in sputum(r(p)=0.575; r(b)=0.745, P<0.01) Conclusion: 1. The level of Survivin, Bcl-2, P53 protein in sputum was significantly higher in lung cancer patients than those of in benign patients and healthy volunteers. It proved that there was relation between Survivin, Bcl-2, P53 and the occurrence and development of lung cancer, and indicated that the occurrence of lung cancer was a canceration procedure with multiple gene participated and a muti-step procedure. 2. The level of Survivin in sputum correlated with that of P53 and Bcl-2 in sputum, this indicated that they play synergetic role in the process of carcinogenesis of lung cancer. 3. The level of Survivin, P53, Bcl-2 protein in sputum can be used as new tumor markers for the early diagnosis of lung cancer. 4. The study proved that there was relation between smoking...
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