乳腺癌放疗前后血清YKL-40浓度与临床特征关系的研究

Research of serum YKL-40 concentrations and clinical characteristics of breast cancer before and after radiotherapy

目的乳腺癌是临床常见恶性肿瘤之一,目前缺乏有效肿瘤标记物,YKL-40与众多肿瘤的发生、发展密切相关。本研究探讨放疗前后血清YKL-40浓度与乳腺癌患者临床分期、病理类型及分子分型之间的关系以及根据放疗前后血清YKL-40浓度变化评价患者预后的价值。方法采用酶联免疫吸附试验测定2011-06-01-2012-12-01甘肃省肿瘤医院放疗科的100例乳腺癌患者放疗前后血清YKL-40浓度,比较YKL-40浓度在TNM分期、病理类型、分子分型间及临床预后放疗前后的变化。结果乳腺癌患者放疗前后血清YKL-40浓度分别为(102.17±22.04)和(91.67±29.18)ng/mL,Z=-3.920,P<0.001;Ⅰ期患者放疗前YKL-40为(93.65±23.79)ng/mL,放疗后为(78.44±18.21)ng/mL,t=1.766,P=0.099;Ⅱ期患者放疗前YKL-40为(96.62±24.81)ng/mL,放疗后为(86.03±16.58)ng/mL,t=2.619,P=0.012;Ⅲ期患者放疗前YKL-40为(115.86±15.70)ng/mL,放疗后为(92.64±21.87)ng/mL,t=3.302,P=0.004;Ⅳ期患者YKL-40放疗前为(125.55±20.33)ng/mL,放疗后为(109.21±16.83)ng/mL,t=2.450,P=0.032;Ⅰ、Ⅱ、Ⅲ、Ⅳ期组间比较,放疗前F=8.367,P<0.001;放疗后F=7.507,P<0.001。Luminal A型患者放疗前YKL-40为(102.16±29.31)ng/mL,放疗后为(87.16±23.59)ng/mL,t=0.814,P=0.422;Luminal B型患者放疗前YKL-40为(103.74±25.97)ng/mL,放疗后为(95.69±25.33)ng/mL,t=1.046,P=0.305;三阴型患者放疗前YKL-40为(107.38±16.81)ng/mL,放疗后为(98.91±17.59)ng/mL;t=1.039;P=0.321;HER-2阳性型放疗前后分别为(97.07±23.68)和(86.47±16.63)ng/mL,t=3.096,P=0.005;各分子分型组间比较,放疗前F=0.558,P=0.644,放疗后F=1.610,P=0.912。浸润性小叶癌患者YKL-40放疗前为(112.23±20.94)ng/mL,放疗后为(106.29±18.13)ng/mL,t=1.348,P=0.201;浸润性导管癌患者YKL-40放疗前为(97.89±20.30)ng/mL,放疗后为(96.03±18.69)ng/mL,t=0.630,P=0.530;组间比较,放疗前差异有统计学意义,F=4.729,P=0.032;放疗后差异无统计学意义,F=3.655,P=0.059。12例乳腺癌患者放疗后血清YKL-40浓度较放疗前升高,88例放疗后血清YKL-40浓度较放疗前降低,2组在随访期内(36个月)远处转移率分别为50.0%(6/12)和13.6%(12/88),χ2=7.157,P=0.007;2组局部复发率分别为66.7%(8/12)和18.6%(16/88),χ2=11.081,P=0.001。2组1、2、3生存率分别为91.7%、83.3%、66.7%和97.7%、93.2%、86.4%,χ2=4.050,P=0.044。结论乳腺癌患者血清YKL-40浓度放疗前高于放疗后,且与乳腺癌分期、病理类型及分子表型具有一定的相关性,其血清浓度值放疗后升高对判断疾病复发、转移有一定的价值。

OBJECTIVE Breast cancer is a common malignant tumor, and it lacks the effective tumor markers with disease. YKL -40 was closely related to the occurrence and development of many tumors. This paper intends to explore the relationship between serum YKL -40 concentrations and clinical stage, pathological type and the molecular phenotype of breast cancer patient before and after radiotherapy,as well as its value in the prognosis of breast cancer. METHODS En- zyme linked immunosorbent assay （ELISA） was used to measure the serum YKL -40 concentrations in 100 patients with breast cancer before and after radiotherapy in Gansu Tumor Hospital from 2011-06 01 to 2012-12 01, and compares the changes of the serum YKL-40 concentrations in clinical stage, pathological type and molecular phenotype. RESULTS The serum YKL-40 concentrations in breast cancer patients before and after radiotherapy were （102.17 ± 22.04） ng/mL and （91.67±29.18） ng/mL, respectively, Z=3.920,P=0.000. It were （93.65±23.79） ng/mL and （78.44± 18.21） ng/mL in stage Ⅰ before and after radiotherapy, t= 1. 766, P= 0. 099; There were significant differences in clinical stage Ⅱ [（96.62±24.81） ng/mL and （86.03±16.58） ng/mL, t=2.619, P 0.012], Ⅲ[（15.86＋15.70） ng/mL and （92.64± 21.87） ng/mL, t=3.302, P=0.004] and Ⅳ [（125.55±20.33） ng/mL and （109.21±16.83） ng/mL, t=2. 450 P =0. 032]. There were also significant differences when comparing those groups both before （F =8. 367, P= 0. 000） and after （F= 7. 507, P = 0. 000） radiotherapy. There were no differences in Luminal A [（102.16 ± 29.31） ng/mLand （87.16±23.59） ng/mL, t =0.814, P=0.422],LuminalB [（103.74±25.97） ng/mI, and （95.69± 25.33） ng/mL, t=1. 046,P=0. 305] and triple negative type [（107.38±16.81） ng/mL and （98.91±17.59） ng/mL, t= 1. 039 ,P=0. 321） before and after radiotherapy. There were significant differences in HER2 positive type before and after radiotherapy, it were （97.07±23.68） ng/mL and （86.47±16.63） ng/mL （t=3.096,P=0.005）. Comparing in the groups, there had no statistical significance both before （F =0. 558, P=0. 644） and after （F =1. 610, P=0. 912） radiotherapy. It were （112.23±20.94） ng/mL and （106.29±18. 13） ng/mL in lobular invasive cancer patient before and after radiotherapy （t=1. 348, P=0. 201） ; It were （97.89±20.30） ng/mL and （96.03±18.69） ng/mL in invasive duc tal carcinoma before and after radiotherapy （t=0. 630,P=0. 530） ; Comparing between two groups, there was significant difference between two groups before radiotherapy （F=4. 729, P = 0. 032） but it had no significance after radiotherapy （F=3. 655, P =0. 059）. The serum YKL -40 concentrations rose on 12 patients while declined in 88 patients after radio therapy. The distance metastasis rates in two groups were 50%（6/12） and 13.6%（12/88）,respectively （χ2 =7. 157,P =0. 007） ; and the local recurrence rates in two groups were 66.7%（8/12） and 18.6%（16/88）respectively （χ2 = 11. 081, P=0. 001） in follow-up period （36 months）. The 1, 2, 3 years survival rates in two groups were 91.7%, 83.30/00, 66.7% and 97.7%, 93.2%, 86.4%respectively （χ2=-4. 050, P=0.044）. CONCLUSIONS The serum YKL-40 con-entrations were higher before radiotherapy than that after treatment in patients with breast cancer. It had certain correla tion with tumor stage, pathological type and molecular phenotype. The increase of serum YKL-40 concentration after ra diotherapy could help to judge the recurrence and metastasis of the disease.