环氧合酶-2表达与简易淋巴结阴性乳腺癌预后模型的补充

Expression of cyclooxysenase-2 in lymph node negative breast cancer lead to perfect the simple prognostic model

背景与目的:环氧合酶-2(cyclooxysenase-2,COX-2)对恶性肿瘤预后判断与治疗的作用首先在结肠肿瘤中得到广泛研究,现在乳腺癌中的研究也逐渐深入,但COX-2在淋巴结阴性的乳腺癌预后研究仍较少报道。本文研究COX-2对淋巴结阴性乳腺癌预后的影响并完善简易预后模型。方法:免疫组化法研究119例淋巴结阴性乳腺癌组织中COX-2的表达,分析其对5年无病生存率的影响、与简易预后模型PI=size+HER2-2.5×age-CT-0.55×(ER×ET)的预后评分的相关性以及对预后模型中危组患者的5年无病生存率影响。结果:COX-2表达阳性的淋巴结阴性乳腺癌患者5年无病生存率、中位生存时间显著低于COX-2表达阴性者(P<0.05)。原简易预后模型低、中、高危患者5年无病生存率、中位生存时间逐渐降低(P<0.05)。COX-2表达阳性率在低、中、高危患者逐渐增高(P<0.05)。在中危组患者中,COX-2表达阳性者的5年无病生存率、中位生存时间(47%,70.55个月)显著低于COX-2表达阴性者(90%,>96个月),两组间差异有显著性(P<0.05)。结论:在淋巴结阴性乳腺癌中,结合COX-2的表达信息可使简易预后数学模型中危组判断预后和临床决策更为准确。

Background and purpose： Cyclooxysenase-2（COX-2） was first researched in colon caner, and extensively studied in breast cancer. However it was rarely reported in lymph node negative breast cancer. This study assessed the effect of expression of COX-2 in the prognosis of lymph node negative breast cancer and its use as information of COX-2 status to perfect the prognostic mathematic model. Methods： The expression of COX- 2 protein was detected by IHC in 119 cases of lymph node negative breast cancer, the survival data was analyzed. Results： Elevated expression of COX-2 was associated with unfavorable distant disease-free survival（74% vs 93.86%）. In subgroups by the simple prognostic model PI=size＋HER2-2.5×age-CT-0.55×（ER×ET）, the 5-year DFS were decreased with subgroups of low-risk, mid-risk and high-risk and the rate of elevated expression of COX-2 was increased with higher risk subgroups. Furthermore, in mid-risk group, the elevated expression of COX-2 was still able to predict poorer prognosis. Conclusion： The information of expression of COX-2 can be used to perfect the simple prognostic mathematic model, thus it would be more effective for treatment of breast cancer with auxiliary lymph nodes metastases.