手术及术后化疗对乳腺癌血液微转移的影响

Effects of operation and postoperative chemotherapy on micrometastasis in blood in breast cancer

目的 探讨乳腺癌血液微转移发生规律以及手术和术后化疗对血液微转移影响。方法 以 40例乳腺癌患者为研究对象 ,根据临床分期分为 3组 ( 0～Ⅰ期、Ⅱ期、Ⅲ期 ) ,运用RT PCR技术 ,以CK 19mRNA为标志物 ,分别检测其术前、术后第 2天、术后第 1疗程化疗后血液微转移发生情况。结果 ①术前血液微转移阳性率为 2 2 5 0 %( 9/4 0 ) ,其中 0～Ⅰ期 0 %( 0 /6)、Ⅱ期 16 0 0 %( 4 /2 5 )、Ⅲ期 5 5 5 6%( 5 /9) ,3组之间有显著差异 (P <0 0 5 )。浸润性导管癌和浸润性小叶癌阳性率分别为 2 3 0 8%和 3 3 3 3 %,无显著差异 (P >0 0 5 )。②术后第 2天血液微转移阳性率为 3 7 5 0 %( 15 /4 0 ) ,手术前后血液阳性率无显著差异 (P >0 0 5 )。③术后首次化疗结束血液微转移阳性率为 2 5 0 %( 1/4 0 ) ,化疗前后血液阳性率差异非常显著 (P <0 0 1)。结论 临床分期越晚 ,出现微转移可能性越大。血液微转移与病理类型无关。术后化疗能降低血液中微转移阳性率 。

Objective To explore the effects of operation and postoperative chemotherapy on micrometastasis in blood in breast cancer. Methods A total of 40 cases of breast cancer were divided into three groups(0-Ⅰ, Ⅱ and Ⅲ stages). CK 19 mRNA as the marker of micrometastasis in peripheral blood samples was detected by RT PCR before operation, on the 2 nd day after operation and the last day of the first course of postoperative chemotherapy, respectively. Results The positive rate of CK 19 mRNA expression in blood was 22 50%(9/40) preoperatively. The positive rates at 0-Ⅰ, Ⅱ and Ⅲ stages were 0%(0/6), 16 00%(4/25) and 55 56%(5/9), respectively. There was significant difference in positive rate between different stages( P <0.05). The positive rates of CK 19 mRNA expression in infiltrating ductal carcinoma and infiltrating lobular carcinoma were 23 08% and 33 33%, respectively. No significant difference in positive rate of CK 19 mRNA expression was found between infiltrating ductal carcinoma and infiltrating lobular carcinoma( P >0 05). The positive rate of CK 19 mRNA expression in blood on the second day after operation was 37 50%(15/40). There was no significant difference in positive rate of CK 19 mRNA expression in blood between preoperation and the second day after operation( P <0 05). The positive rate of CK 19 mRNA expression in blood on the last day of the first postoperative chemotherapy course was 2 50%(1/40). Postoperative chemotherapy showed a significant influence on the CK 19 mRNA expression. Conclusion Micrometastasis is in a stage dependent manner, but is not related with pathological grading. Postoperative chemotherapy is a kind of routine treatment since it can decrease positive rate of micrometastasis significantly.