新辅助化疗后乳腺癌组织中survivin表达及其与Ki-67、AI的相关性研究

Research in the Expression of Survivin Protein after the Neo-adjuvant Chemotherapy of Breast Neoplasm and Relativity with Ki-67、AI

目的探讨采用CTF方案新辅助化疗后乳腺癌组织中凋亡抑制蛋白survivin的表达及其与肿瘤细胞凋亡、增殖的相互关系和临床意义。方法采用免疫组化SABC法,检测60例行新辅助化疗和60例未行新辅助化疗的乳腺癌组织中survivin和Ki-67的表达,并采用原位细胞末端转移标记法(TUNEL法)测定细胞凋亡指数(AI)。结果新辅助化疗组survivin阳性表达率为36.7%(22/60),明显低于对照组(71.7%,43/60)(χ2=14.821,P<0.001)。新辅助化疗组Ki-67阳性表达率(38.3%,23/60)明显低于对照组(61.7%,37/60,χ2=6.533,P<0.05)。新辅助化疗组AI均数为(9.34±3.12)%,对照组AI均数为(5.27±3.16)%,两组比较差异有统计学意义(γ=1.998,P<0.05)。新辅助化疗组survivin表达与AI呈负相关(γ=-0.36,P<0.05),而与Ki-67表达呈正相关(γ=+0.47,P<0.05)。新辅助化疗组化疗总有效率为73.3%(44/60),化疗后部分缓解(Ⅱ级)病例survivin表达水平(18.2%,8/44)明显低于无效(Ⅲ级)病例(81.3%,13/16)(χ2=20.514,P<0.001)。结论应用CTF方案新辅助化疗,缓解率高,近期疗效明显。Survivin表达水平可作为预测乳腺癌新辅助化疗疗效的指标。

Objective To explore the clinical significance of survivin protein expression in breast cancer with neo-adjurant chemotherapy as well as the inter-relationship to one another between the expression and apoptosis and proliferation. Methods The expressions of survivin protein and Ki67 antigen of cancer cells were detected by SABC immunohistocbemical technique in （30 cases of breast cancer with and 60 cases without preoperative neo-adjuvant chemotherapy with CTF regimen. Apoptosis index （AI） of tumor cells was assayed by TdT-mediated Dutp nick end labeling （TUNEL）. Results The positive expression rate of survivin protein（36.7% ,22/60） in nco-adjuvant chemotherapy group was significantly lower than that（71.7% ,43/60） in control group（ X2 = 14.821 ,P 〈0.001 ）. The positive expression rate of Ki-67（38.3% ,23/60） in neo-adjuvant chemotherapy group was significantly lower than that （ 61.7% ,37/60） in control group （ X^2 = 6. 533,P 〈 0.05 ）. Tumor cell AI in neo-adjuvant chemotherapy group was obviously higher compared to control group （ t = 1. 998, P 〈 0.05 ）. The overall response rate of the neo-adju- rant chemotherapy was 73.3 %. There is a significantly inverse relationship between survivin and AI（ X^2= -0.36, P 〈 0.05 ）, but significantly positive relationship between the expression of survivin and Ki-67 in neo-adjuvant chemotherapy group（γ= ＋ 0.47, P 〈0.05 ）. In neo-adjuvant chemotherapy group, the positive rate（ 18.2%, 8/44）in PR（ 11 degree） cases was markedly lower than that（81.3% ,13/16）in NC（Ⅲdegree） cases（x2 =20.514,P〈0.001）. Conclusion Preoperative neo -adjuvant chemotherapy with CTF regimen is effective to breast cancer. The expression level of survivin protein in breast cancer may predict the response to neo- adjuvant chemotherapy.