上皮细胞黏附分子表达与乳腺癌的分子分型及预后

Expression of epithelial cell adhesion molecule and molecular subtypes and prognosis of breast cancer

目的:探讨上皮细胞黏附分子(epithelial cell adhesion molecule,Ep CAM)在乳腺癌及其分子亚型中表达的临床病理及预后意义。方法:采用免疫组织化学Max VisionTM法检测835例乳腺浸润性导管癌中Ep CAM的表达,分析其与临床病理特征和预后的关系。结果:Ep CAM的阳性表达与组织学分级、淋巴结转移、肿瘤大小、ER和PR表达、HER2表达和临床分期均有关(均P<0.05),与绝经状态无关(χ2=0.117,P=0.733)。在腺腔A型、腺腔B型(HER2-)、腺腔B型(HER2+)、HER2过表达型及三阴型乳腺浸润性导管癌(invasive ductal carcinoma,IDC)中,Ep CAM的阳性表达率分别为19.2%,73.0%,48.9%,72.2%和62.1%。Log-rank检验和单因素COX分析显示Ep CAM阳性患者的预后较差(均P<0.001),并与三阴型、腺腔B型(HER2-)和HER2过表达型预后有关(均P<0.05)。多因素COX分析显示Ep CAM阳性表达与三阴型和HER2过表达型预后差相关(均P<0.05)。结论:Ep CAM可能与乳腺癌进展有关,并与分子分型相关,在乳腺癌总体上及三阴型和HER2过表达型中是一种独立的预后因子。

Objective： To investigate clinicopathological and prognostic significance of epithelial cell adhesion molecule（Ep CAM） expression in breast cancer and its molecular subtypes.Methods： The expression of Ep CAM in 835 patients with breast invasive ductal carcinoma was detected by immunohistochemical Max VisionTM method, and its correlation with clinical pathological features and prognosis was analyzed.Results： The positive expression of Ep CAM was related to histological grade, lymph node metastasis, tumor size, clinical stage, the expression of estrogen receptor（ER）, progesterone receptor（PR） and HER2（P〈0.05）. The positive expression rates of Ep CAM were 19.2%, 73%,48.9%, 72.2%, and 62.1%, in Luminal A, Luminal B（HER2-）, Luminal B（HER2＋）, HER2＋, and triple-negative subtype, respectively. Log-rank test and univariate COX analysis showed that the Ep CAM expression was associated with a poor prognosis in all patients（P0.001）, as well as the triple-negative subtype, luminal B subtype（HER2-）, and HER2＋ subtype（P〈0.05）. Multivariate COX analysis showed that Ep CAM expression was associated with the survival in patients with the triple-negative or HER2＋ subtype（P〈0.05）.Conclusion： Ep CAM may be associated with progress of breast cancer. It is an independent prognostic factor in breast cancer, especially in the triple-negative and HER2＋ subtypes.