乳腺癌组织中P-糖蛋白表达及临床意义

The expression of P-glycoprotein in breast carcinoma

目的探讨复发转移性乳腺癌mdr-1基因表达产物P-糖蛋白(P-glycoprotein,P-gp)表达及其与联合化疗疗效的关系。方法应用SABC法检测40例转移性乳腺癌术后组织中P-gp表达,使用环磷酰胺、吡喃阿霉素和5-氟尿嘧啶联合方案化疗,对比分析P-gp表达与疗效的关系。结果40例患者mdr-1基因表达产物P-gp阳性表达率52.5%,肝或肺转移者阳性表达明显高于皮肤或淋巴结转移者。40例患者化疗有效率57.5%;P-gp阴性组疗效(84.2%)明显优于P-gp阳性组(33.3%)(P<0.01),有肝或肺转移者有效率(35.2%)明显低于皮肤或浅表淋巴结转移者(78.5%)(P<0.05)。术后曾接受辅助性CAF或CMF方案化疗者复发转移后化疗疗效33.3%和73.6%,差异有统计学意义(P<0.05)。结论mdr-1基因表达产物P-gp表达阳性者应选择非多药耐药型药物的联合方案化疗。

Objective To study P-glycoprotein（P-gp）,the mdr-1 gene product,expression and response to pirarubicin containing regimen in recurrent and metastatic breast carcinoma, Methods P-gp expression in 40 postoperative patients with recurrent and metastatic breast carcinoma was detected by SABC immunohistochemical method. The patients were treated with combination regimen of cyclophosphamide, pirarubicin and 5-fluorouracil, The correlation between P-gp expression and chemotherapeutic response was analyzed. Results The positive rate of P-gp expression in patients with lung or liver metastasis was higher than that in skin or lymphnode metastasis（ P = 0. 049） ; The overall response rate was 52.5 % in 40 patients; The responserate 84.2 % of the P-gp negative group was higher than that 33.3 % of the P-gp positive group（P 〈 0.01 ）, The response rate（78.5 % ） in the patients with skin or lymphnode metastasis was higher than that （32.5 % ） of the patients with lung or liver metastasis （ P 〈 0.05）. In the post operative patients who had received CAF or CMF regimen adjuvant chemotherapy previously, the response rate of metastatic diseases to chemotherapy had significant difference 33.3 % and 73.6 %, respectively（ P 〈 0.05）. Conclusion Patients with P-gp positivere current and metastatic breast carcinoma should be treated with chemotheraphy combined with non-MDR drug.