血清HER-2单独及联合检测在乳腺癌随访中的意义

Significance of serum human epidermal growth factor receptor-2 alone and its combined determination with other serum markers in the follow-up study for breast cancer patients

目的:乳腺癌的随访常以CA15-3及CEA等作为监测肿瘤进展的指标,但其敏感性仍不能满足临床需要。而组织中HER-2(human epidermal growth factor receptor,人表皮生长因子受体-2)基因的过表达已被证实与乳腺癌患者预后较差相关。本研究目的即初步确立乳腺癌患者治疗后随访单独或者联合检测的指标。方法:应用酶联免疫技术(ELISA法)对44例乳腺癌患者进行治疗前后血清HER-2水平的测定,并取同步血清样本行肿瘤标志物CEA、CA15-3及血清VEGF、b-FGF、EGF的检测。对所有患者进行每半年的随访直至病情进展。结果:乳腺癌患者血清HER-2水平在治疗后明显下降(14.23ng/mlvs.6.39ng/ml),在出现复发转移的患者中明显升高(21.73ng/mlvs.5.36ng/ml)。血清HER-2单独检测时特异性最高,达80.95%;联合检测血清HER-2及b-FGF的敏感性最高,达90.91%;联合检测血清HER-2及CA15-3的诊断准确性最高,达78.05%。随访结果显示,治疗后血清HER-2水平及CA15-3水平是影响乳腺癌患者的无进展生存的主要因素。结论:血清HER-2随着乳腺癌患者病情进展而升高,且便于检测,可独立或与CA15-3联合检测作为患者随访的指标。

Objective：CA15 -3 and CEA, the most common serum markers of follow -up study, seem not so sen- sitive to monitor the tumor progression of breast cancer in our clinical practice nowadays. Whereas it is reported that the overexpression of Her - 2/neu in breast tissue was well related to the poor prognosis of patients. This study was to find out the more accurate serum markers, single or combined, to follow - up in breast cancer patients. Methods ： ELISA essay was applied to test the serum expressions of HER - 2 in 44 female breast cancer patients before and after chemotherapy and/or radiation therapy. Meanwhile the diagnostic value of the HER -2 expression was in comparison with that of the vascular endothelial growth factor （VEGF）, basic fibroblast growth factor/（ b -FGF）, epidermal growth factor（ EGF）, CEA and CA15 - 3 detected concurrently. Fallow - up studies were performed every six months until disease progression. Results：The serum HER -2 in breast cancer had a significant decrease after the treatment （14.23ng/ml vs. 6.39ng/ml）. They were related to the tumor progression, and their levels significantly elevated in the progression group（21.73ng/m1 vs. 5.36ng/ml）. We also found that the specificity of serum HER - 2 alone in de- termination of disease progression was 80.95% ,combined determination of serum HER- 2 and b -FGF showed the highest sensitivity of 90.91% ,while serum HER -2 and CA15 -3 showed the highest accuracy rate of 78.05%. The logistic model demonstrated that serum HER -2 level and CA15 -3 level after treatment were the main prognostic factors of progression - free survival. Conclusion： Serum HER - 2 level increased with tumor progression. As it is easy to detect,it can be used alone or combined with CA15 -3 in follow -up studies for breast cancer patients.