导管原位癌中粉刺型坏死与侵袭转移的相关性

The relationship between comedo-type necrosis and invasion or metastasis of ductal carcinoma in situ

背景与目的粉刺型坏死是导管原位癌预后不良的因素之一,肿瘤细胞侵袭和转移是预后不良的主要原因。本研究拟分析乳腺导管原位中粉刺型坏死与侵袭转移指标间的关系,探讨前者是否与导管原位癌侵袭转移有关。方法按照WHO标准将导管原位癌分成粉刺型和非粉刺型两组,对两组间ER、PR、HER-2、Cathepsin-D、P53蛋白的表达以及癌细胞微浸润、淋巴结受累等指标进行卡方检验。结果在粉刺型和非粉刺型导管原位癌中,ER表达分别为45.3%和63.0%,(P=0.002);PR表达分别为43.6%和55.6%,(P=0.04);HER2(-)、HER2(+)、HER2(++)、HER2(+++)表达分别为15.6%、42.2%、27.9%和28.1%,33.5%、19.3%、19.0%和10.4%(P=0.001);Cathepsin-D表达分别为73.2%和57.8%(P=0.005);P53表达分别为50.8%和43.7%(P=0.254);癌细胞微浸润率分别为46.9%和31.2%(P=0.008);淋巴结受累率分别为10.6%和3.7%(P=0.03)。结论粉刺型坏死与多种侵袭转移因素相关,提示粉刺型导管原位癌相对容易发生侵袭转移。

Background and purpose： Comedo necrosis is one of the poor prognostic factors in DCIS, and both invasion and metastasis of cancer are the main causes for poor prognosis. In this study, we will analyze the relationship between comedo necrosis and pathological factors, and study whether there is correlation between eomedo necrosis and invasion or metastasis of cancer. Methods： Based on WHO criteria, 314 cases are divided into two groups： comedo type and non-comedo type DCIS groups. The different expressions of ER,PR ,HER-2 ,Cathepsin-D and the rate of microinvasion ,lymph-node involved were analyzed by immunohistochemistry method. Results： In comedo and non-comedo type DCIS group, the rate of micro-invasion is 46.9% vs. 31.2% （ P =0. 008）, the rate of lymph-node involved is 10.6% vs. 3.7% （ P = 0.03） ; the immunoreactivity for ER positive expression is 45.3% and 63.0% （ P = 0. 002） ; PR positive expression is 43.6% and 55.6% （P=0.04） ,Cathepsin-D positive expression is 72.6% vs. 57.8% （P=0. O05）, P53 positive expression is 50. 8% vs. 43.7% （P=0.254）,respectively;and the rates of HER2（ -）,HER2（ ＋）,HER2（ ＋ ＋）,HER2（ ＋ ＋ ＋） expression is 15.6% vs. 42.2% ,27.9% vs. 28. 1% ,33.5% vs. 19.3% , 19.0% vs. 10.4%, respectively （ P = 0001）. Conclusions： The primary results suggest that comedo type DCIS is relatively more prone to invasion or metastasis than noncomedo type DCIS and the different expressions of genes in the two groups might contribute to the difference.