乳腺浸润性导管癌ER、PR、CerbB-2、Ki-67表达与临床病理及预后的关系

Expressions of ER,PR,CerbB-2 and Ki-67 marker genes and their relationships with clinical pathology and prognosis in primary invasive ductal breast cancer

目的观察乳腺浸润性导管癌患者生物学特征与临床病理及生存率的相关性,探讨这些生物学特征在临床诊断及预后中的价值。方法收集临床资料,采用免疫组化检测女性原发性乳腺浸润性导管癌324例患者的ER、PR、CerbB-2、Ki-67的表达状况,与患者的临床病理学如病理类型和组织学分级等因素相结合进行比较,并结合随访资料分析上述指标与患者预后的关系。结果乳腺浸润性导管癌术后生物学指标中,乳腺癌组织分级与CerbB-2、Ki-67阳性表达正相关(P=0.0498,P=0.0404);pTNM分期与CerbB-2、Ki-67阳性表达正相关。单因素生存分析显示ER、PR、CerbB-2和Ki-67阳性表达是乳腺癌复发的影响因素,而CerbB-2阳性表达对总生存率的影响有统计学意义(P<0.001)。多因素Cox模型分析显示CerbB-2、Ki-67阳性表达是影响乳腺癌复发的独立因素,而CerbB-2、Ki-67阳性表达是影响生存期的独立因素。结论CerbB-2、Ki-67指标与乳腺癌的组织学分级相关,CerbB-2、Ki-67阳性表达和乳腺癌pTNM分期相关。影响乳腺癌患者预后的独立因素有ER、PR、CerbB-2、Ki-67,其中CerbB-2、Ki-67阳性表达是预后不良的指标,ER、PR阳性表达是预后良好的指标。

Objective To observe the relationship between biological markers including ER, PR, CerbB-2 and Ki-67 and clinical pathology such as survival rate in female patients with primary invasive ductal breast cancer, and to explore values of these biological markers in clinical prognosis. Methods A total of 324 specimens of female primary invasive ductal breast cancer were stained for PR, CerbB-2, Ki-67 by two-step immunohistochemical approach. All the patients were followed up and clinical data were collected, including the expression of ER, PR, CerbB-2 and Ki-67 and analyzed for their relationship with clinical pathology, such as histological gradeing, pTNM stages, and follow-up results of prognosis. Results Among the postoperational immunohistochemical indicators of breast cancer, positive expression of CerbB-2 and Ki-67 positively correlated with the histopathology grading and pTNM stages. Results of univariate survival analysis showed that ER, PR, CerbB-2 and Ki-67 were influencing factors for recurrence of breast cancer, while CerbB-2 and Ki-67 affected the overall survival rate significantly. Outcomes of multivariate analysis by Cox proportional hazard model demonstrated that CerbB-2, Ki-67 were independent factors for recurrence of breast cancer, and high expressions of CerbB-2, Ki-67 were factors for overall survival rate as well. Conclusion Among biological indicators of breast cancer patients, CerbB-2 and Ki-67 are positively associated with histological grading, while the high expressions of CerbB-2 and Ki-67 are associated with pTNM stages. The independent factors of the prognosis in patients with breast cancer are ER, PR, CerbB-2 and Ki-67, and high expressions of CerbB-2, Ki-67 are the indicators of poor prognosis, while expressions of ER and PR are the indicators for benign prognosis.