人乳腺癌预后COX风险比例模型分析及Clusterin表达相关意义

COX proportional hazards model analysis on breast cancer prognosis and the correlation with clusterin expression

目的：分析人乳腺癌惠者预后相关危险因素，明确不同因素在影响乳腺癌患者预后中的作用，阐述Clusterin在人乳腺癌组织中表达的临床意义。方法：收集1993～1994年临床预后资料完整的手术切除乳腺癌石蜡包埋组织158例，癌旁组织31例，制作成组织芯片进行Clusterin免疫组化染色，计算染色指数，对影响乳腺癌惠者生存预后相关因素进行COX风险比例模型分析和生存分析，C｜usterin表达与患者预后、淋巴结转移、肿瘤大小、病理类型和复发之间的相关关系。结果：COX风险比例模型分析结果显示，淋巴结转移和肿瘤大小是影响患者预后最危险的两种因素，B值分剐为-0.494和0.142，P值分别为0.001和0.009；生存分析结果显示，Clusterin阳性表达、淋巴结转移和术后化疗6次以下（不包括6次）均明显差于Clusterin阴性表达（X^2=14.085，P=0.000）、无淋巴结转移（X^2=21.458，P=0.000）和术后化疗〉6次（X2=4.442，P=0.035）；相关分析结果显示。Clusterin染色指数大小和肿瘤大小具有正相关关系，r=0.249，P=0.002，肿瘤细胞Clusterin表达明显高于癌旁正常乳腺上皮细胞（t=3.131，P=0.003），有淋巴结转移的肿瘤细胞Clusterin表达染色指数明显高于无淋巴结转移肿瘤，t=7.152，P=0.000。结论：淋巴结转移和肿瘤大小影响患者生存预后。作为一种凋亡抑制蛋白，Clusterin与乳腺癌的发生和转移有关。

OBJECTIVE： To investigate the signifi-cance of clusterin （CLU） expression as a risk factor for breast cancer through tissue microarray technology and un-ivariate analysis of overall survival. METHODS： Formalin-fixed, paraffin-embedded tissues from 158 cases of breast cancer and 31 cases of normal adjacent tissues assembled into a tissue microarray. Cytoplasmic CLU expression in tumor tissues was measured by immunochemistry. Surviv-al analysis was used to investigate the relationship between CLU expression and prognosis, tumor volume, pathologi- cal classification and recurrence. RESULTS.. The survival time of patients with CLU expression, lymph node metas-tasis and limited post-surgery chemotherapy （〈6 cycles of treatment） was significantly shorter than that of patients with no detectable CLU expression （X^2 = 14.085, P =0.000）, without lymph node metastasis （X^2=21.458,P=0.000） and more comprehensive post-surgery chemothera-py （≥6 cycles of treatment） ,X^2 =4.442,P=0.035. CLU expression in tumor cells was higher than that in normal adjacent breast epithelial cells, t= 3.131, P=0.03. The CLU expression staining coefficient of cancer tissues with lymph node metastasis was higher than that of ones with-out lymph node metastasis, t = 7.152, P=0.000. CON-CLUSION： Cytoplasmic CLU expression is a prognosis factor for human breast cancer.