上皮钙黏蛋白、波形蛋白和Snail蛋白表型在乳腺浸润性导管癌中表达的相关性及其与预后的关系

Expression of E-cadherin, Vimentin and Snail in infiltrating ductal carcinoma and their relationships with prognosis

目的 检测上皮钙黏蛋白（E-cadherin）、波形蛋白（Vimentin）和Snail蛋白在乳腺浸润性导管癌中的表达情况与乳腺癌病理特征的关系及其与浸润性导管癌预后的关系.方法 采用Envision免疫组织化学方法对89例乳腺浸润性导管癌组织中的上E-cadhenn,Vimentin和Snail蛋白表达情况进行检测并分析表达程度与临床病理特征之间的关系;统计分析采用卡方检验、Fisher精确概率法检验Spearman等级相关检验、配对计数资料检验、Kaplan-Meier法进行单因素生存分析,Cox比例风险模型进行生存的多因素分析.结果 E-cadherin、Vimentin和Snail蛋白在浸润性导管癌组织中的阳性表达率分别为、47.1％、53.9％和55.0％,三者呈负相关,（P=0.003）;E-cadherin、Vimentin和Snail蛋白的表达与临床TNM分期有关（P ＜0.005）.浸润性导管癌中Snail蛋白、Vimentin表达明显增高,Snail蛋白与淋巴结转移有关（P =0.029）;Vimentin与淋巴结转移、雌激素状态有关（P =0.006,P＜0.001）;E-cadherin表达明显降低,与孕激素状态有关（P =0.030）;分子分型结果显示,管腔A型、HER-2阳性型组的Vimentin、Snail蛋白阳性表达率低于基地细胞样型组（P =0.012）,而E-cadherin表达率则高于基地细胞样型组（P =0.004）.Cox分析发现,E-cadherin低表达和Vimentin的过度表达与患者总生存期（P =0.019、P=0.045）及患者无病生存期（P =0.032、P=0.024）显著相关,但Snail蛋白的表达与总生存期及无病生存期无相关性（P =0.879、P=0.835）.结论 E-cadhern、Vimentin和Snail蛋白在乳腺浸润性导管癌的发生、发展、侵袭及转移中起重要作用,对认识乳腺癌的生物学特性以及对指导乳腺癌的诊疗及预后具有重要意义.

Objective To investigate the expression of E-cadherin,Vimentin,Snail in breast cancer,and the correlations between these protein with clinicopathologic features and clinical prognosis.Methods Inmunohistochemistry analysis was used to examine the expression levels of E-cadherin,Vimentin,and Snail in 89 cases of breast-infiltrating ductal carcinoma.Correlations between the expression of E-cadherin,Vimentin,and Snail with clinicopathologic features were analyzed.Results E-cadherin,Vimentin and Snail positive rate in infiltrating ductal carcinoma tissue was 51.7%,53.9% and 55.0%,the negative correlation were showed （P =0.003）.E-cadherin,Vimentin and Snail were correlated with clinicopathological stage （P 〈 0.001）.Snail and Vimentin were highly expressed in invasion of ductal carcinomal （IDC）.Snail expression was closely associated with lymph node metastasis （P =0.029）.Vimentin expression was closely associated with lymph node metastasis and estrogen receptor （ER） status （P =0.006,P 〈 0.005）.E-cadherin expression was closely associated with progestrone receptor（PR） status （P =0.030）.Luminal type A,HER-2 positive patients of Vimentin and Snail positive rates were lower than Basal-like type breast cancer patients （P =0.012）.E-cadherin expression rate was higher than Basal-like type breast cancer patients （P =0.004）;Kaplan-Meier survival analysis demonstrated that the five-year survival was higher for patients with E-cadherin-positive tumors,while it was lower for those with vimentin,snail positive tumors.E-cadherin and vimentin levels were independent prognostic factors for favorable outcomes of IDC as determined by Cox multivariate analysis （P =0.032,P =0.024）,while Snail expression has no correlation with the outcome （P =0.879,P =0.835）.Conclusion The E-cadherin,Vimentin and Snail protein of expression played an important role in the invasion,metastasis and development of breast invasive ductal carcinoma.It is of great significance to recognize the biological characteristics of breast cancer and in order to guide the diagnosis and treatment.