2025 年第 10 期 第 20 卷

肺癌患者痰液细胞DNA倍体与临床特征及预后的关系

Relationship between DNA ploidy of sputum cells and clinical features and prognosis in patients with lung cancer

作者：姚俊强慕晓艳朱丽华肖凌刘吟絮侯宛昕周蕾李和根

英文作者：Yao Junqiang Mu Xiaoyan Zhu Lihua Xiao Ling Liu Yinxu Hou Wanxin Zhou Lei Li Hegen

单位：上海中医药大学附属龙华医院肿瘤科，上海200032

英文单位：Department of Oncology Longhua Hospital Shanghai University of Traditional Chinese Medicine Shanghai 200032 China

关键词：肺癌；痰液细胞学；DNA倍体分析；临床分期；预后因素；生存分析

英文关键词：Lungcancer;Sputumcytology;DNAploidyanalysis;Clinicalstage;Prognosticfactors; Survivalanalysis

• 摘要：

• 目的 探究痰液细胞DNA倍体与肺癌患者病理特征、临床分期、进展及预后的关系。方法 选取上海中医药大学附属龙华医院肿瘤科2019年5月至2021年6月就诊、经细胞学或组织病理学检查确诊为原发性肺癌的患者162例。按年龄、性别、是否放化疗、吸烟史、家族史、病理类型、分期、是否复发转移进行分类，并对患者病史、体格检查及影像学检查进行随访，随访时间截止至2024年12月。用χ2检验分析肺癌患者痰液细胞DNA倍体与肺癌临床病理类型、分期、进展情况的相关性，运用Cox多因素分析方法分析肺癌患者痰液细胞DNA倍体结果等因素与肺癌预后的相关性。Kaplan-Meier法进行痰液细胞DNA倍体结果相关的生存情况分析。结果 不同组织分型肺癌患者DNA倍体异常发生率比较差异无统计学意义(χ2=1.194，P=0.551）。肿瘤分期晚期肺癌患者DNA倍体异常发生率高于早期患者［66.7%（44/66）比40.6%（39/96）］（χ2=10.616，P=0.001）。DNA倍体异常在复发转移患者中的发生率为66.2%（51/77），在无复发转移患者中的发生率为37.6%（32/85），差异有统计学意义（χ2=13.214，P<0.001）。Cox多因素分析结果显示放疗（风险比=0.429，95%置信区间：0.252～0.731，P=0.002）是肺癌患者预后的保护性因素，痰液细胞DNA倍体结果阳性（风险比=3.065，95%置信区间：1.830～5.135，P<0.001）、吸烟史（风险比=4.467，95%置信区间：2.606～7.657，P<0.001）均是肺癌患者预后的危险因素。Kaplan-Meier生存分析结果显示痰液细胞DNA倍体阳性表达者生存率较阴性表达者低，两条生存曲线差异有统计学意义（χ2=18.387，P=0.003）。结论 痰液细胞DNA倍体分析技术是一种客观性强、可重复性好、易于被患者接受的检测手段，痰液细胞DNA倍体分析技术对肺癌患者的筛查、进展及预后情况评估具有较好的临床意义，可同其他诊断方式一起作为肺癌患者诊断及预后判断的有效检测手段。

• Objective To investigate the relationship between DNA ploidy in sputum cells and pathological characteristics, clinical stage, progression and prognosis of lung cancer patients. Methods A total of 162 patients with primary lung cancer confirmed by cytology or histopathology in Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine from May 2019 to June 2021 were selected. The patients were classified according to age, gender, radiotherapy and chemotherapy, smoking history, family history, pathological type, stage, recurrence and metastasis. The patients were followed up by medical history, physical examination and imaging examination until December 2024. The χ2 test was used to analyze the correlation between DNA ploidy of sputum cells and clinicopathological types, stages and progression of lung cancer. Cox multivariate analysis was used to analyze the correlation between factors such as DNA ploidy of sputum cells and the prognosis of lung cancer. Kaplan-Meier method was used to analyze the survival related to DNA ploidy results of sputum cells. Results There was no significant difference in the incidence of abnormal DNA ploidy in lung cancer patients with different histological types (χ2=1.194, P=0.551). The incidence of abnormal DNA ploidy in advanced lung cancer patients was higher than that in early stage patients ［66.7%(44/66) vs 40.6%(39/96)］(χ2=10.616, P=0.001). The incidence of abnormal DNA ploidy in patients with recurrence and metastasis was 66.2% (51/77), and that in patients without recurrence and metastasis was 37.6% (32/85), the difference was statistically significant (χ2=13.214, P<0.001). Cox multivariate analysis showed that radiotherapy (hazard ratio=0.429, 95% confidence interval: 0.252-0.731, P=0.002) was a protective factor for the prognosis of patients with lung cancer, while positive sputum cell DNA ploidy results (hazard ratio=3.065, 95% confidence interval: 1.830-5.135, P<0.001) and smoking history (hazard ratio=4.467, 95% confidence interval: 2.606-7.657, P<0.001) were risk factors for the prognosis of patients with lung cancer. The results of Kaplan-Meier survival analysis showed that the patients with positive DNA ploidy expression in sputum cells had a lower survival rate than those with negative DNA ploidy expression, and the difference between the two survival curves was statistically significant (χ2=18.387, P=0.003). Conclusion Sputum DNA ploidy analysis is an objective , reproducible and easy to be accepted by patients. Sputum DNA ploidy analysis has good clinical significance for the screening, progression and prognosis evaluation of patients with lung cancer, and can be used as an effective detection method for the diagnosis and prognosis of patients with lung cancer together with other diagnostic methods .