iNOS在不同乳腺病理组织中的表达水平及其与肿瘤临床预后的相关性

目的:检测诱导型一氧化氮合酶（iNOS）在正常乳腺组织、不典型增生、原位癌以及浸润性乳腺癌组织中的表达水平，探讨其与浸润性乳腺癌临床相关病理指标及临床预后相关性。方法:收集148例不同乳腺病理组织（28例不典型增生、40例导管内癌及80例浸润性乳腺癌）以及20例正常乳腺组织，使用免疫组化SP法检测各组中iNOS的表达水平。分析浸润性乳腺癌中iNOS表达水平与肿瘤大小、腋窝淋巴结受累情况、TNM分期等临床病理指标，以及与临床预后的相关性。结果:iNOS在乳腺正常组织中未见阳性表达；而在乳腺不典型增生组织、原位癌组织及浸润性乳腺癌组织中阳性率分别为25.0%、52.5%及78.8%，各组间差异有统计学意义（均P<0.05）。在浸润性乳腺癌中，随着临床分期越晚及肿瘤直径越大，iNOS染色阳性率逐渐升高。在原位癌中iNOS染色阳性组5年无病生存率（61.9%）低于阴性组（84.2%），差异有统计学意义（P<0.05）；而在浸润性乳腺癌中，iNOS染色阳性组5年无病生存率（63.5%）与阴性组（70.6%）无统计学差异（P>0.05）。结论:iNOS在乳腺癌发生的早期阶段（不典型增生）即已出现表达升高，其表达水平与临床分期与肿瘤直径相关，并影响原位癌患者预后。因此，iNOS可作为乳腺癌早期诊断及预后评估的潜在指标。

Expression and clinical significance of iNOS in breast cancer

Objective:To study the expression of iNOS in normal breast tissue，atypical hyperplasia，ductal carcinoma in situ and invasive carcinoma tissues，and analyze the association between iNOS expression and pathological features and clinical outcome in breast cancer.Methods:Expression of iNOS was detected in 20 normal breast tissues，28 atypical hyperplasia，40 ductal carcinoma in situ (DCIS) and 80 invasive carcinoma tissues by immunohistochemistry (IHC) technique.We also analyzed the association between the positive staining percent of iNOS and the clinical and pathology features such as tumor diameter and lymph node status in 80 cases of invasive breast cancer.Results:iNOS could not be detected in normal breast tissue.The positive staining percent of iNOS in atypical hyperplasia，DCIS and invasive breast cancer were 25.0%，52.5% and 78.8%，respectively，with a statistical difference between any two groups of them (all P<0.05).Higher positive staining percent of iNOS was observed in advanced TNM stage and larger tumor diameter.The 5-year disease free survival rate of iNOS positive group (61.9%) was significantly lower than the negative group (84.2%) in patients with ductal carcinoma in situ (P<0.05).While there was no statistical difference of 5-year disease free survival rate between iNOS positive and negative groups in patients with invasive carcinoma (P>0.05).Conclusion:High expression of iNOS could be detected in atypical hyperplasia tissues.The iNOS expression levels were correlated with tumor stage and diameters，and associated with clinical prognosis.Thus，iNOS might serve as a potential diagnostic and prognostic biomarker for breast cancer patients.