基于CD34、α-SMA和β-Tubulin-Ⅲ三联标记的肺腺癌浸润性评估体系构建及临床意义

doi:10.3969/j.issn.1671-7171.2026.06.014

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摘要 【目的】探讨CD34、α-平滑肌肌动蛋白(α-SMA)及β-Ⅲ微管蛋白(β-Tubulin-Ⅲ)联合检测在肺腺癌浸润性判定中的价值。【方法】收集肺腺癌手术标本100例,其中原位腺癌(AIS)15例、微浸润性腺癌(MIA)35例及浸润性腺癌(IA)50例。检测肺腺癌标本CD34、α-SMA及β-Tubulin-Ⅲ表达,并结合术后随访资料分析其临床意义。【结果】AIS、MIA及贴壁为主型IA生长区域主要表现为CD34网格状阳性、α-SMA基底膜线状阳性的“双轨征”;腺泡型及实性型IA主要表现为CD34缺失、α-SMA间质强阳性的“一消一强”模式;乳头型IA呈“不均匀线状”表达。β-Tubulin-Ⅲ在AIS及大部分贴壁区域中呈阴性表达,在IA中表达明显升高,且与浸润程度相关(均P<0.05)。随访显示,AIS/MIA患者多行亚肺叶切除且预后良好;贴壁为主型IA与AIS/MIA组无复发或转移的生存率比较,差异无统计学意义(P>0.05),而其他类型IA复发或转移风险显著高于AIS/MIA组及贴壁为主型IA组(均P<0.05)。【结论】CD34、α-SMA及β-Tubulin-Ⅲ联合检测有助于提高肺腺癌浸润判定的准确性,可为AIS/MIA亚肺叶切除策略及IA个体化外科决策提供病理学依据。

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	蔡霖
	林勇

关键词 ：肺肿瘤, 肿瘤浸润, 抗原,CD34, 肌动蛋白类, 微管蛋白

Abstract：【Objective】 To investigate the value of the combined detection of CD34, α-smooth muscle actin (α-SMA), and β-Ⅲ tubulin (β-Tubulin-Ⅲ) immunostaining for assessing invasiveness in lung adenocarcinoma. 【Methods】 We retrospectively analyzed 100 resected lung adenocarcinomas, including 15 adenocarcinoma in situ (AIS), 35 minimally invasive adenocarcinomas (MIA), and 50 invasive adenocarcinomas (IA). The CD34, α-SMA, and β-Tubulin-Ⅲ expressions were evaluated by immunohistochemistry and correlated with clinicopathological findings and follow-up data. 【Results】 AIS, MIA, and lepidic-predominant IA mainly showed a "double-track" pattern, which was characterized by reticular CD34 positivity and linear α-SMA staining along the basement membrane. In contrast, acinar- and solid-predominant IA showed a "loss-and-gain" pattern, which exhibited the loss of CD34 expression and strong stromal α-SMA positivity, whereas papillary-predominant IA showed an irregular linear pattern. β-Tubulin-Ⅲ was negative in AIS and most lepidic areas, but its expression was significantly upregulated in IA and correlated with invasive extent (all P<0.05). Follow-up data demonstrated favorable outcomes in AIS/MIA, most of whom underwent sublobar resection. Recurrence/metastasis-free survival did not have statistical significance between lepidic-predominant IA and AIS/MIA groups (P>0.05), whereas the risk of recurrence or metastasis in other types of IA was significantly higher than that in the AIS/MIA group and the lepidic-predominant IA group (P<0.05). 【Conclusion】 The combined detection of CD34, α-SMA, and β-Tubulin-Ⅲ aids in improving the accuracy of determining true invasion in lung adenocarcinoma, thereby providing a pathological basis for sublobar resection strategies in AIS/MIA and for individualized surgical decision-making in invasive adenocarcinomas.

Key words： Lung Neoplasms Neoplasm Invasiveness Antigens, CD34 Actins Tubulin

收稿日期: 2025-11-05

中图分类号:

R734.2

通讯作者: *E-mail:linyong00@sina.com

引用本文:

蔡霖, 林勇. 基于CD34、α-SMA和β-Tubulin-Ⅲ三联标记的肺腺癌浸润性评估体系构建及临床意义[J]. 医学临床研究, 2026, 43(6): 930-934.
CAI Lin, LIN Yong. Construction of an Invasiveness Assessment System for Lung Adenocarcinoma Based on Triple Markers of CD34, α-SMA, and β-Tubulin-Ⅲ and its Clinical Significance. JOURNAL OF CLINICAL RESEARCH, 2026, 43(6): 930-934.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2026.06.014 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2026/V43/I6/930

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