目的:探讨核苷酸切除修复交叉互补基因1( Excision Ｒepair Cross Complementation l，EＲCC 1) 和核
苷酸还原酶亚单位M 1( Subunit M l of Ｒibonucleotide reductase，ＲＲM 1) 分子标志物指导下的化疗药物选择在晚
期NSCLC 病人治疗中的有效性及安全性。方法: 68 例III 或IV 期NSCLC 病人采用免疫组织化学方法检测分子
标志物的蛋白表达。将晚期NSCLC 病人分为分子标志物指导治疗组( A 组) 及对照组( B 组) 。A 组用分子检测
方法检测EＲCC 1、ＲＲM 1 分子标志物，并根据检测结果确定化疗方案。B 组为未经分子标志物检测的经验治疗
组。经过化疗后，观察两组的疗效、无进展生存期( progressive－free survival，PFS) 、总生存期( overall survival，OS)
及化疗过程中的不良反应。结果:基于分子标志物检测指导下选用的化疗方案比经验性化疗方案的有效率明显
提高( χ2 = 5． 707，P= 0． 017) ，PFS 明显延长( P= 0． 04) ，差异有统计学意义; 两组OS 无显著性差异; 不良反应无
明显差异。结论:分子标志物指导下的化疗方案能够提高化疗有效率，显著延长疾病无进展生存时间。吉西他
滨+顺铂方案在分子标志物指导药物选择的策略下应用，将取得更高的治疗缓解率。

Objective: To explore the efficacy and safety of EＲCC 1 and ＲＲM 1molecular markers
that guided strategy of chemotherapy in advanced NSCLC． Methods: This study randomly selected 68
cases of NSCLC patients who are stage III or IV． It was based on whether target tissue is appropriate for
immunohistochemical detection of molecular markers． The advanced NSCLC were divided into two
groups: molecular marker guide therapy group ( A) and control group ( B ) ． The group A was
determined by the expression of EＲCC 1 and ＲＲM 1 and according to the molecular marker to select
the chemotherapy drugs． The group B was no molecular marker pre－selection． After the treatment with
chemotherapy， the clinical outcome，progressive－free survival( PFS) ，overall survival ( OS) and toxic
adverse reactions from chemotherapy were compared between the two groups． Ｒesults: The group A has
shown significant improvement in efficacy( χ2 = 5． 707，P = 0． 017) as well as statistically significant extension
in PFS( P = 0． 04) comparing to the Group B． There was no significant difference in OS and
toxic adverse reactions between the two groups． Conclusion: The chemotherapy which selected based on
the molecular markers could significantly improve the efficacy and extend PFS． The chemotherapy regimens
of gemcitabine plus cisplatin can achieve higher clinical remission used by the guidance of molecular
marker in the advanced NSCLC．

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 收稿日期:2014－09－08; 修回日期:2014－10－10
基金项目:吴阶平基金( 320． 6799． 1133)
作者简介:东丽( 1973－) ，女，蒙古族，内蒙古自治区人民医院肿瘤内科医师，医学博士。
通讯作者:张翠英，主任医师，医学硕士，E－mail: cenyao－2006@126． com 内蒙古自治区人民医院， 010017