α-SMA与ALDH1在乳腺癌中的表达及临床意义

Expression and clinical significance of α-SMA and ALDH1 in breast carcinoma

目的平滑肌肌动蛋白α(α-SMA)和乙醛脱氢酶1(ALDH1)分别为乳腺癌间质成纤维细胞及乳腺癌干细胞的特征性标志物。本研究通过检测α-SMA、ALDH1在乳腺癌中的表达,探讨其与乳腺癌临床预后的关系。方法免疫组化检测182例乳腺癌患者及36例正常乳腺或良性疾病患者α-SMA、ALDH1的表达,分析二者之间的相关性及其与乳腺癌临床疾病特征及生存预后的关系。结果α-SMA在正常乳腺组织及乳腺良性病变组织的间质成纤维细胞中无表达(0%),182例乳腺癌中有117例(67.6%)α-SMA阳性;ALDH1在36例正常或良性乳腺疾病和182例乳腺癌中的阳性率分别为16.7%(6/36)和37.9%(69/182)。α-SMA与ALDH1的表达呈正相关(P<0.05)。α-SMA的表达与肿瘤大小相关(P<0.05),肿瘤直径大于2cm者α-SMA的阳性率较高;ALDH1的表达与组织分化程度、脉管浸润与否及远处转移与否相关(P<0.05),分化程度差、有脉管癌栓及远处转移的患者ALDH1阳性率较高。182例乳腺癌患者中α-SMA阳性表达组5年生存率较阴性组无明显降低(P>0.05);ALDH1阳性表达组5年生存率较阴性组低,与预后呈负相关(P<0.05)。α-SMA和ALDH1的表达情况以及孕激素受体情况、是否接受术前化疗、有无复发、远处转移等6个因素与总生存期有关(P<0.05),均为乳腺癌的独立预后因素。结论α-SMA、ALDH1均可能与乳腺癌的发生及发展有关。二者之间的表达正相关,提示肿瘤相关成纤维细胞(TAFs)可能与乳腺癌的干性有关。联合检测α-SMA、和ALDH1有助于判断疾病的恶性程度、浸润能力及转移潜能,可作为预测乳腺癌预后的新指标。

Objective To investigate the expression and clinical significance of α-SMA and ALDH1 in breast carcinoma. Methods In this study, the breast samples were colleceted from both 182 patients with breast carcinomas and 36 with breast diseases or normal breast tissue. Immunohistochemistry was used to detect the expression of α-SMA and ALDH1 in both breast carcinomas and normal or benign breast tissues. Correlations between α-SMA and ALDH1 with clinical prognosis factors and survival status were analyzed statistically. Results The positive rate of α-SMA was significantly higher in breast carcinomas than in controls （67.6% vs 0 %, P0.001）. The positive rate of ALDH1 was higher in breast carcinomas than in controls （37.9% vs 16.7%,P0.05）. The expression of α-SMA was positively correlated to the expression of ALDH1（P0.05）. α-SMA was associated with tumor size. The expression of α-SMA was higher in the tumor when the size was larger than 2 cm. The high expression rate of ALDH1 was correlated to tumor differentiation, the infiltration of vessel,and distant metastasis（P0.05）. The expression of ALDH1 was higher in poor tumor differentiation,positive vessel infiltration and distant metastasis. The five year＇s survival were not significantly different between the comparative two subgroup of the expression of α-SMA（P0.05）. The five year＇s survival was shorter in breast carcinoma patients with high expression of ALDH1 than in those with low expression of ALDH1 （P0.05）. Cox regression analysis demonstrated that the overall survival was related to both the expression of α-SMA and ALDH1, the status of progestin receptor, receiving neoadjuvant chemotherapy or not, tumor recurrence and distant metastasis （P0.05）, they’re all the independent prognosis factors of breast carcinoma. Conclusions Both α-SMA and ALDH1 are potentially related to the generation and progression of breast carcinoma. The high expression of α-SMA was positively related to ALDH1 expression,which means TAFs maybe contribute to the generation of the stemness of breast carcinoma.Thus,detection of the two markers may contribute to the judgment of the grade malignancy, the ability of tumor infiltration and the potency of metastasis.