Follow-up Study Of Expression Of P53, Bcl-2 And Caspase-3 And Prognosis In Patients With Non Small Cell Lung Cancer

ObjectiveThe aim of this study was to test the expression of p53, bcl-2 and caspase-3 in elderly patients with Non Small Cell Lung Cancer(NSCLC), to explore the difference between the expression of the three proteins and the elderly patients with advanced NSCLC based on platinum chemotherapy in clinical characteristics, curative effect of chemotherapy and prognosis, and to discuss the relationship between chemotherapy with platinum as the first-tier treatment and chemotherapy safety, and to provide evidence and guidance for medication care, strengthening the safety of chemotherapy, and community health education for patients.MethodsA number of 117 NSCLC patients who experienced a lung cancer surgery during February 2007 and February 2008 in the First Affiliated Hospital to Liaoning Medical College, with a completed clinical data, paraffin tissue sample and follow-up information, were involved in this study. Immunohistochemical techniques were used to detective the expression of p53, bcl-2 and caspase-3 protein in NSCLC, the drug safety, curative effect of chemotherapy, survival time of followed-up patients, and 5 years survival rate; The correlation of the expression of the three proteins and effect and prognosis and the relationship in chemotherapy with platinum between security treatment were analyzed in SPSS 17.0 statistical software.Results1、The expression of p53 protein was 42.74% in NSCLC. Low, medium, well-expression of p53 protein were respectively 72.09%, 25.49%, 26.09% with statistically significance(P<0.05) in NSCLC patients of different degrees; the correlations between low and medium-expression, low and well-expression both were statistically significant(P<0.05). In different pathological types of NSCLC, the positive expression of p53 protein in squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, large cell carcinoma, the other type were 68.09%, 32.69%, 0.00%, 20.00% and 0.00%, with statistically significant difference(P<0.05). Among them, the squamous cell carcinoma and the other 4 types, adenocarcinoma and the other type had statistically significance(P<0.05). In different lymph node metastasis of NSCLC, the p53 protein expression with and without lymph node metastasis were 54.55% and 32.26%(P<0.05); different general classification of NSCLC, the p53 protein expression of central and peripheral-type were 70.00%, 14.04%(P<0.05). MST of patients with positive and negative expression of p53 protein in NSCLC tissues were 12 months and 24 months. Five-year survival rate of patients with positive and negative p53 expression were 2.00% and 11.94% with statistically significance in test(P<0.05).2、The expression of bcl-2 protein in NSCLC was 38.46% and the bcl-2 protein expression in low, medium, well-differentiated tissue were 16.28%, 35.29%, 86.96 %(P<0.05) in various differentiation degrees of NSCLC; all of their correlations were statistically significant(P<0.05). In different lymph node metastasis of NSCLC, bcl-2 protein expression with or without lymph node metastasis were 60.00% and 19.35%(P<0.05); MST of patients with positive and negative expression of bcl-2 protein in NSCLC tissues were 13 months and 15 months. Five-year survival rate were 8.89% and 6.94%, without significant difference(P>0.05) in test.3、The expression of caspase-3 protein in NSCLC is 36.75%, and the caspase-3 protein expression of low, medium, well-differentiated tissues were 25.58%, 27.45%, 78.26%(P<0.05), in which, low and well-expression, medium and well-expression both were statistically significant(P<0.05). In different lymph node metastasis of NSCLC, caspase-3 protein expression with or without lymph node metastasis were 27.27% and 45.16%(P<0.05); MST of patients with positive and negative expression of caspase-3 protein in NSCLC tissues were 25 and 13 months, and 5-year survival rate were 9.30% and 6.76% without significant difference(P>0.05) in test.4、Compared with platinum-treatment and regimens security of elderly patients with advanced NSCLC, leukopenia of NP chemotherapy group was more severe than the other three programs(P<0.05); constipation and diarrhea of TP chemotherapy group showed more frequently than the other three programs(P<0.05); thrombocytopenia of GP and OP chemotherapy was more prominent than the other two programs(P<0.05); there was no statistically significance(P>0.05) in neurological toxicity, renal insufficiency, and stomach discomfort.5、Cox regression multivariate stepwise regression analysis showed that: different clinical stages and degrees of differentiation is the most important factor of the prognosis of patients with lung cancer(P<0.05).Conclusions1 、 The expression of p53 protein in NSCLC tissues had substantial connections with the degrees of differentiation, histological types, lymph node metastasis, and tumor gross types. The expression of p53 protein in NSCLC tissues is related to prognosis, and 5-year survival rate and MST of the patients with low expression are higher than ones with high expression.2、The expression of bcl-2 protein in NSCLC tissues was closely related to differentiation, lymph node metastasis, and patient prognosis.3、The expression of caspase-3 protein in NSCLC tissues had closely connections with differentiation and lymph node metastasis, and had no connection with prognosis.4 、 Platinum-treatment and regimens security of elderly patients with advanced NSCLC were substantial connected. NP patients tended to suffer from neutropenia, TP patients tended to diarrhea and constipation, GP and OP patients were likely to get thrombocytopenia.5、Different stages and degrees of differentiation are the most important factors of lung cancer patients’ prognostic. p53 protein expression may provide effective information for clinical and community nurses to care and follow-up on elderly patients with advanced NSCLC.