恶性胸腹水和实体肿瘤患者多药耐药基因表达的检测及临床意义

Clinical significance of MDR gene expression in malignant pleural effusion and ascites and solid tumors

目的 探讨多药耐药相关基因表达对肿瘤化学药物治疗 (化疗 )效果监测的指导意义 ;了解原发性乳腺癌多药耐药基因 1 (MDR1 )和谷胱甘肽S 转移酶 (GST π)mRNA共表达及其与临床和预后的关系。方法 采用半定量RT PCR方法检测 1 6例恶性胸腹水肿瘤细胞和 1 0 2例实体肿瘤多药耐药基因MDR1的mRNA的表达 ,以及其中 84例乳腺癌MDR1和GST π的mRNA共表达。结果 ( 1 )1 6例恶性胸腹水肿瘤细胞和 1 8例实体肿瘤组织MDR1的mRNA表达水平与临床化疗效果的平均符合率为 85 0 %。 ( 2 ) 84例原发性乳腺癌组织中MDR1mRNA表达的阳性率为 79 8% ,且中、高表达为3 3 3 % ;GST π的阳性表达率 3 3 3 % ,而中、高表达仅为 4 8% ,2组比较差异有非常显著的意义 (P <0 0 1 ) ;术前化疗组的MDR1mRNA阳性率 87 8% ,与术前未化疗组的 68 6%比较 ,差异有显著意义 (P<0 0 5) ;MDR1mRNA表达阳性率在腋淋巴结转移组中为 89 1 % ,淋巴结无转移组中为 68 4 % ,2组比较差异有显著意义 (P <0 0 5) ;在术后有复发转移组中GST πmRNA阳性率为 71 4 % ,与无复发转移组的 2 0 6%比较 ,差异有显著意义 (P <0 0 5) ;GST πmRNA表达阳性率在雌激素受体 (ER)、孕激素受体 (PR)阳性组中 ,比ER、PR阴性组高 ,2组比较差异有显著意义 (P

Objective To discuss the guiding significance of multidrug resistance (MDR) gene expression for monitoring the clinical effectiveness of chemotherapy upon cancer, and to analyze the MDR1 and glutnthione s transferase(GST π) mRNA expression rates in primary breast cancer, and their correlation with the clinical outcome and prognosis. Methods The mRNA expression levels of MDR1 in 16 cases with malignant pleural effusion and ascites and 102 cases of solid tumors were measured using semiquantitative RT PCR assay. The MDR1 and GST π mRNA expression rates in 84 cases of breast cancer, out of the 102 cases of solid tumors, were also studied in the same way. Results (1) An average coincidence rate of 84.5% was found between the mRNA expression level of MDR1 and the clinical response to chemotherapy in the 16 cases with malignant pleural effusion and ascites and 18 cases of solid tumors. (2) The positive rate of MDR1 mRNA expression in primary breast cancer tissue was 79 7%, with the medium and high levels as high as 33 3%, while the positive rate of GST π mRNA expression was 33 3%, with the medium and high expression levels being as low as 4 8%. There was a highly significant difference between the two groups ( P <0 01). The positive rates of MDR1 mRNA in the group having received chemotherapy before surgery and the group not receiving chemotherapy before surgery were 87 8% and 68 6% respectively, showing a lymph nodes and in the group without metastases in axillary lymph nodes were 89 1% and 68 4% respectively, indicating a significant difference ( P <0 05). The positive rates of GST π mRNA in the group suffering distant metastases and the group not suffering distant metastases were 71 4% and 20 6% respectively, showing a significant difference ( P <0 05). The GST π mRNA expression rates in the estrogen receptor (ER) and progesterone receptor (PR) positive groups were higher than those in the ER and PR negative groups, indicating a significant difference ( P <0 05). Conclusion The mRNA expression level of MDR1 has a relatively high correlation with the clinical response to chemotherapy, and thus can be used to monitor the effectiveness of chemotherapy. MDR1 is the main drug resistance mechanism in breast cancer. Chemotherapy before surgery induces MDR1 mRNA expression. MDR1 e xpression and GST π mRNA expression serve as a significant prognostic indicator for breast cancer, thus having guiding significance for assessing prognosis.