腋淋巴结阴性乳腺癌外周血hMAM检测意义

目的:应用乳腺癌特异性标志物乳腺珠蛋白(hMAM)检测腋淋巴结阴性乳腺癌(axillary lymph node negative breast cancer,ALNNBC)外周血中微转移,并探讨其与临床病理因素的关系.方法:采用巢式RT-PCR方法,分别检测62例ALNNBC、6例乳腺良性疾患和6例健康成人女性外周血中hMAM mRNA的表达,并以MDA-MB415细胞为阳性参考检测该方法的灵敏度.结果:ALNNBC外周血hMAM表达阳性率为32.3%(20/62),乳腺良性疾患组和健康成人女性组全部阴性表达;该方法检测外周血微转移的灵敏度达1/106;C-erbB2基因阳性表达者微转移发生率高(P＜0.01),月经状态、肿瘤大小、组织学类型、ER状态、p53表达等与微转移无关(P＞0.05);复发转移组较无瘤生存组外周血中微转移率高(P＜0.01).结论:hMAM可作为乳腺癌外周血微转移的标志物;ALNNBC微转移与C-erbB2密切相关;外周血微转移可以作为ALNNBC预后指标.     

Establishment of an apoptosis-sensitive rat mammary carcinoma cell line with a mutation in the DNA-binding region of p53

The objective of this study was mainly to develop and evaluate a membrane array-based method simultaneously detecting the expression levels of a multiple mRNA marker panel in the peripheral blood for used in complementary breast cancer diagnosis. The mRNA markers employed included cytokeratin 19 (CK-19), carcinoembryonic antigen (CEA), c-Met, Her2/neu, and mammaglobin (hMAM). The specimens of peripheral blood were collected from 80 healthy women and 102 female patients with breast cancer. The expression levels of molecular markers were evaluated by real-time Q-PCR and membrane array. Data obtained from real-time Q-PCR and membrane array were subjected to linear regression analysis, revealing that there was a high degree of correlation between the results of these two methods (r=0.979, P<0.0001). The result of membrane array assay with a combined panel of five mRNA markers was demonstrated to achieve sensitivity of 80.6%, and specificity of 83.8% for breast cancer detection, much higher than those of analysis of single marker. In addition, we demonstrated that the membrane array method could detect circulating cancer cells at a density as low as five cancer cells per 1 ml of blood. The analysis of correlation between the outcome of membrane array and clinicopathological characteristics indicated that overexpression of the multiple marker panel was significantly correlated with tumor size (P=0.030) and TNM stage (0.009). In conclusion, the detection of circulating cancer cells by means of membrane array simultaneously monitoring five mRNA markers could significantly enhance the sensitivity and specificity for cancer cell detection.     

SBEM和hMAM在乳腺癌中的表达及临床意义

目的 探讨乳腺上皮粘蛋白（SBEM）和人乳腺珠蛋白（hMAM）在乳腺癌中的表达及其临床意义。方法 采用实时荧光定量PCR（RT-PCR）检测109例乳腺癌患者和25例对照组（5例健康者与20例其他肿瘤患者）外周血SBEM mRNA和hMAM mRNA的表达情况,流式细胞术检测SBEM和hMAM阳性表达细胞的比例;并分析其与临床病理特征的关系。结果 RT-PCR检测显示SBEM mRNA和hMAM mRNA仅表达于乳腺癌患者外周血中,在健康者和其他肿瘤患者外周血中无表达。流式细胞术检测显示SBEM和hMAM在乳腺癌患者中阳性表达细胞的比例分别为55.9％和40.4％,而在健康者和其他肿瘤患者中仅为10％左右。乳腺癌外周血SBEM和hMAM表达与TNM分期、淋巴结转移有关,而与年龄、肿瘤大小、激素受体和C erbB-2均无关。结论 SBEM mRNA和hMAM mRNA在乳腺癌患者外周血中均有高表达,两者联合检测有助于判断血道微转移的存在。     

Immunocytochemical detection of breast cancer cells in marrow and peripheral blood of patients undergoing high dose chemotherapy with autologous stem cell support

Summary Detection of small numbers of breast cancer cells is important in staging the disease and can be helpful in assessing the efficacy of purging regimens prior to autologous stem cell infusion. Immunohistochemical methods are potentially useful and broadly applicable for this purpose since they are simple to perform, sensitive, and may be quite specific. We have used a combination of four monoclonal antibodies [260F9, 520C9, 317G5 (Baxter Corp); BrE-3 (Dr. R. Ceriani)] against tumor cell surface glycoproteins in a sensitive immunocytochemical assay to identify breast tumor cells in bone marrow and peripheral blood. Immunostained cytospin preparations were fixed prior to staining to preserve cytological details of immunopositive cells. After immunostaining, slides were counterstained with hematoxylin to confirm the identity of labeled cells. In cytocentrifuge experiments in which small numbers of CAMA human breast tumor cells were added to bone marrow mononuclear cells, a linear relationship between the number of tumor cells added and the number of tumor cells detected was obtained over a broad range of tumor cell concentrations. The probability of detecting tumor cells was dependent on the number of cytocentrifuge slides examined. When ten slides (5 million cells) were examined, the probability of detecting tumor at a concentration of 4 tumor cells per million bone marrow mononuclear cells was 98%. In clinical specimens, tumor cells were detected in marrow aspirates from 73 of 240 (30%) patients undergoing autologous transplantation, including 70 (37%) of 190 patients with clinical stage IV disease, 0 of 7 patients with clinical stage III disease, and 3 of 43 (7%) patients with clinical stage II disease. Seventy-three of 657 peripheral blood specimens from 26 of 155 patients (17%) contained breast cancer cells with counts ranging from 1 to 97 tumor cells per million leukocytes. Tumor cells were most frequently found in the blood of patients with stage IV disease [21 of 107 (20%)] but were also found in a substantial number [5 of 44 (11%)] of patients with stage II disease. Positive selection of CD34-positive hematopoietic progenitor cells as well as negative purging methods such as incubation with 4-hydroxyperoxy-cyclophosphamide (4-HC) were evaluated with respect to tumor cell depletion. Selection of CD34-positive progenitor cells from bone marrow or peripheral blood resulted in log reduction of 1 to > 4 tumor cells reinfused at autologous transplantation. A lesser log reduction (up to 1) was demonstrated following 4-HC purging. We conclude that properly performed and controlled immunocytochemical staining of bone marrow and peripheral blood cytospins is a sensitive and simple way to detect and quantitate breast cancer cells in hematopoietic specimens harvested for autotransplantation and that CD34-positive progenitor cell selection results in significant reduction in the number of breast cancer cells reinfused with marrow or peripheral blood stem cells.     

乳腺癌患者外周血hMAM及SBEM检测及其临床意义

目的研究乳腺癌患者外周血人乳腺珠蛋白（hMAM）及乳腺上皮粘蛋白（SBEM）的表达及临床意义。方法应用逆转录聚合酶链反应（RT-PCR）技术检测58例乳腺癌患者外周血hMAM mRNA及SBEM mRNA的表达，并用健康志愿者及乳腺良性肿瘤患者各10例作为对照。结果hMAM及SBEM在58例乳腺癌患者外周血的阳性表达率分别为34.5%、25.9%，乳腺良性肿瘤和正常对照均无阳性表达，两者的阳性表达与患者的临床分期显著相关（P〈0.05），两者联合检测的总阳性率为41.4%（24/58），与单一标志物相比缺乏统计学意义。结论hMAM及SBEM特异性表达于乳腺癌外周血，可作为检测乳腺癌外周血肿瘤细胞标志物，并有可能在乳腺癌微转移诊断和预后判断中具有重要意义。     

Detection of tumor-specific genetic alterations in bone marrow from early-stage breast cancer patients

Detection of genetic markers associated with early breast cancer may prove clinically relevant for identifying patients at increased risk for relapse. Loss of heterozygosity (LOH), a specific genetic aberration, commonly occurs during breast cancer initiation and metastasis. Early detection of tumor metastasis to bone marrow (BM) using conventional histochemical techniques has been limited because of suboptimal efficiency and sensitivity. Because bone is such a common site of breast cancer recurrence, we sought to determine whether microsatellite markers associated with breast cancer could be detected in BM aspirates from patients with early-stage breast cancer. Cell-free plasma from BM aspirates in 48 patients was assessed for LOH using a panel of eight polymorphic microsatellite markers. LOH was detected in 11 (23%) of 48 patients' BM aspirates. Advancing American Joint Committee on Cancer (AJCC) stage was associated with an increased incidence of LOH. Concordance was present between LOH identified in BM aspirates and matched-pair primary tumors. No samples contained detectable tumor cells on routine histology. In 24 patients, paired peripheral blood serum samples were available for analysis. In these cases, BM detection of LOH was more frequent than serum. This study demonstrates the novel finding of tumor-related genetic markers in BM aspirate plasma of early-stage breast cancer patients and provides a unique approach for assessing subclinical systemic disease progression and the monitoring of breast cancer patients.     

无假基因干扰的CK19 RT-PCR方法检测乳腺癌外周血微转移

目的:以CK19为基因标志检测乳腺癌患者外周血中播散的肿瘤细胞,并对其临床意义进行评价。方法:采用优化的无假基因干扰的RT-PCR方法检测乳腺癌患者外周血有核细胞的CK19mRNA表达。结果:1)方法可靠性验证:检测30例正常人外周血CK19mRNA表达,结果无假阳性;将乳腺癌细胞系MCF-7以1∶107与正常外周血有核细胞混合,检测CK19mRNA表达,结果无假阴性。2)检测乳腺癌41例,外周血肿瘤细胞阳性检出率26.8%(11/41);乳腺癌患者外周血肿瘤细胞阳性率在患者不同年龄、肿瘤大小、临床分期、组织学分级、ER和PR状态的各组间差异无显著性(P>0.05);淋巴结转移阳性病例外周血肿瘤细胞检出率(38.1%)明显高于淋巴结转移阴性组(15.0%),虽然统计学差异不具有显著性(P=0.10),但提示淋巴结转移阳性的患者肿瘤细胞血行播散的危险性有增加的趋势。结论:以CK19为基因标志采用RT-PCR方法检测乳腺癌患者外周血中的肿瘤细胞可能是乳腺癌有意义的预后指标,可以为治疗方案的选择、治疗疗效的评价及外周血干细胞移植联合大剂量化疗适应证筛选提供重要依据。     

Detection of circulating epithelial cells in the blood of patients with breast cancer: comparison of three techniques

This study compares the sensitivities and specificities of three techniques for the detection of circulating epithelial cells in the blood of patients with breast cancer. The number of circulating epithelial cells present in the blood of 40 patients with metastatic breast cancer and 20 healthy volunteers was determined by: immunomagnetic separation (IMS) and laser scanning cytometry (LSC), cell filtration and LSC and a multimarker real-time RT-PCR assay. Numbers of cytokeratin-positive cells identified and expression of three PCR markers were significantly higher in the blood of patients with breast cancer than in healthy volunteers. Using the upper 95% confidence interval of cells detected in controls to determine positive patient samples: 30% of patients with metastatic breast cancer were positive following cell filtration, 48% following IMS, and 60, 45 and 35% using real-time RT-PCR for cytokeratin 19, mammaglobin and prolactin-inducible peptide. Samples were significantly more likely to be positive for at least one PCR marker than by cell filtration (83 vs 30%, P<0.001) or IMS (83 vs 48%, P<0.001).The use of a multimarker real-time RT-PCR assay was therefore found to be the most sensitive technique for the detection of circulating epithelial cells in the blood of patients with breast cancer.     

hMAM RNA 和CEA RNA T-PCR检测乳腺癌外周血微转移

目的应用RT-PCR法检测乳腺癌患者外周血中的human ammaglobin(MAM)mRNA和CEA RNA表达情况.方法用RT-PCR法,检测52例乳腺癌患者外周血中hMAM RNA和CEA RNA的表达情况,另抽取28例乳腺良性疾病患者和10例健康志愿者外周血标本作为对照.结果 52例乳腺癌患者外周血中hMAM RNA和CEA RNA的阳性率分别为30.8％、34.6％.28例乳腺良性疾病患者和10例健康志愿者外周血中hMAM RNA、CEA RNA表达均为阴性.两者的阳性表达均与患者的腋淋巴结状况、TNM分期差异有显著性意义(P<0.05).而与患者的年龄、原发肿瘤大小、病理类型以及激素受体状况等均无显著性差异(P＞0.05).结论 hMAM RNA、CEA RNA均可作为标志物来检测乳腺患者外周血中微转移,联合检测可增加外周血中循环肿瘤细胞的检测率.