Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Relation between ERCC1 Expression in Sputum and Survival after Cisplatin-Based Chemotherapy in Patients with Non-Small Cell Lung Cancer

비소세포 폐암환자의 객담 내 ERCC1 발현정도와 cisplatin 복합화학요법 후 치료반응

  • Yang, Sung Woo (Department of Internal Medicine, Kosin University, College of Medicine) ;
  • Choi, Pyoung Rak (Department of Internal Medicine, Kosin University, College of Medicine) ;
  • You, Hong Jun (Department of Internal Medicine, Kosin University, College of Medicine) ;
  • Kim, Jin Gu (Department of Internal Medicine, Kosin University, College of Medicine) ;
  • Oak, Chul Ho (Department of Internal Medicine, Kosin University, College of Medicine) ;
  • Jang, Tae Won (Department of Internal Medicine, Kosin University, College of Medicine) ;
  • Jung, Maan Hong (Department of Internal Medicine, Kosin University, College of Medicine)
  • 양성우 (고신대학교 의과대학 내과학교실) ;
  • 최평락 (고신대학교 의과대학 내과학교실) ;
  • 류홍준 (고신대학교 의과대학 내과학교실) ;
  • 김진구 (고신대학교 의과대학 내과학교실) ;
  • 옥철호 (고신대학교 의과대학 내과학교실) ;
  • 장태원 (고신대학교 의과대학 내과학교실) ;
  • 정만홍 (고신대학교 의과대학 내과학교실)
  • Received : 2005.11.25
  • Accepted : 2006.01.23
  • Published : 2006.02.28
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Abstract

Background : Excision repair cross complementing gene 1 (ERCC1) not only has a protective role against carcinogens, but plays an important role in cisplatin-resistance via the repair of cisplatin-DNA adducts. This study investigated the association between the ERCC1 expression levels in sputum and survival after cisplatin-based chemotherapy in patients with inoperable non-small cell lung cancer (NSCLC). Methods : Using the sputum collected from 67 inoperable (stage IIIa-IV) NSCLC patients treated with either taxanes (33 cases) or gemcitabine (34 cases) plus cisplatin, the relative expression levels of ERCC1 and the expression of the tumor specific antigen, MAGE, were examined by the quantitative RT-PCR and RT-PCR, respectively. The response and survival were compared with the relative level of ERCC1 or MAGE expression and the treatment modality. Results : In the sputum, ERCC1 and MAGE was detected in 74.6% and 40.2% of patients, respectively. Using the median ERCC1 level, the patients were classified as having high or low ERCC1 expression. The median overall survival (MST) was significantly longer in patients with a high ERCC1 expression level than those with a low expression level (84 weeks vs. 44 weeks respectively, P=0.017). In the taxene-based treatment group, the MST was longer than the gemcitabine group (79 weeks vs. 47 weeks, respectively, P=0.03). The levels of ERCC1 were significantly higher in patients who were MAGE-positive (P=0.003). In the MAGE-negative patients, the MST was longer in the high ERCC1 group (103 weeks vs. 43 weeks, P=0.008), but not in the MAGE-positive patients (62 weeks vs. 44 weeks, P=0.348). Conclusion : ERCC1 expression in the sputum can be a prognostic factor for survival after chemotherapy in patients with inoperable NSCLC.

목 적 : 폐암치료에 가장 널리 사용되는 cisplatin은 DNA와 결합하여 DNA 복제를 방해한다. 이렇게 손상된 부위를 복구하는 과정에 excision repair cross complementing gene 1 (ERCC1)이 작용한다. ERCC1이 활성화 되면, 정상세포는 DNA 손상을 줄일 수 있지만 종양세포의 경우 cisplatin의 효과는 감소하게 된다. 비소세포 폐암(non-small cell lung cancer, NSCLC) 환자에서 cisplatin을 포함하는 화학치료를 할 경우 예후인자로서 객담 ERCC1 정량측정의 의의를 조사하였다. 대상 및 방법 : 2001년 4월부터 2003년 8월 사이에 NSCLC로 진단되어 cisplatin과 taxane계(33명) 혹은 cisplatin과 gemcitabine(34명) 복합 화학치료를 받은 환자를 대상으로 하였다. 기관지 내시경검사를 실시한 후에 즉각 채취한 객담을 처리하여 c-DNA를 분리한 후, 객담속의 종양특이 유전자인 melanoma antigen gene (MAGE) 발현 여부는 RT-PCR로, ERCC1의 상대적 정량적 측정은 real-time PCR로 하였다. 환자의 치료반응 및 생존기간과 MAGE 발현여부 및 ERCC1의 발현정도와의 상관관계를 조사하였다. 결 과 : 객담에서 MAGE는 40.2%, ERCC1은 74.6%에서 발현되었다. ERCC1이 중앙값 이상인 경우와 미만인 군으로 나눠서 비교한 결과 ERCC1이 증가된 군의 중앙생존기간이 84주로 미만인 군의 44주보다 길었다(P=0.017). Taxane계를 사용한 군의 중앙생존기간이 79주로 gemcitabine 사용군의 47주에 비해 길었다(P=0.03). MAGE의 발현 여부는 생존기간과 유의한 관계는 없었으나, MAGE 발현군에서 ERCC1이 유의하게 증가되어 있었다(P=0.003). MAGE가 발현되지 않고 ERCC1이 증가된 군의 중앙생존기간은 103주로 그렇지 않은 군의 43주보다 길었고(P=0.008), MAGE가 발현된 경우는 두 군 간에 차이가 없었다(각각 62주 및 44주, P=0.348). 결 론 : NSCLC 환자의 객담에서 ERCC1을 정량 측정하는 것이 화학치료를 받는 환자의 생존기간을 예측하는 한 인자로 유용할 것으로 추정된다.

Keywords

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