五种乳腺癌预后相关指标在乳腺肿瘤中的表达及其临床意义

目的为明确细胞增殖核抗原(Ki-67)、DNA含量及倍体情况、微血管密度(MVD)、组织蛋白酶D(cathepsin-D)、端粒酶(hTERT)在乳腺癌中的表达,及其与乳腺癌淋巴结转移的关系,为乳腺癌预后提供有价值的信息。方法运用图像分析系统对Ki-67、MVD及DNA含量进行定量检测;用免疫组织化学S-P法检测90例乳腺癌、28例乳腺癌前病变、25例乳腺良性病变中cathepsin-D、hTERT基因蛋白、Ki-67、抗第8因子-RA(FⅧ-RA)的表达。结果Ki-67标记指数、微血管密度、细胞DNA相对倍体均值(U值)按乳腺良性病变、乳腺癌前病变及乳腺癌的顺序呈递增趋势,且随乳腺癌分级的增高而显著增高。Cathepsin-D与肿瘤大小,组织学分级、淋巴结转移雌激素受体(ER)、孕激素受体(PR)呈正相关(P<0.05),与C-erbB-2呈负相关(P<0.05);hTERT在乳腺癌与癌前病变组,乳腺癌与良性病变组间差异有统计学意义(P<0.05),与组织学分级ER、PR、p53表达呈正相关(P<0.05),与肿瘤大小、淋巴结转移情况无关。结论U值和Ki-67标记指数均能较好地反映肿瘤细胞增殖活性。细胞增殖活性的测定可以间接预测乳腺癌患者淋巴结转移情况及乳腺癌预后。Cathepsin-D对乳腺癌淋巴结转移及预后有明显的提示作用。肿瘤MVD反映血管生成,是淋巴结转移的重要指标。多种指标的联合应用有助于提高乳腺癌预后预测的正确性。

Five prognosis-related markers and their expression and clinical significance in breast tumor

Objective To examine the Ki-67,microvascular density(MVD),DNA content and ploidy condition and the expression of cathepsin-D,hTERT protein in breast cancer, combining the expression of ER,PR,p53,C-erbB-2 and tumor size, histological grading to make clear the relationship between these biomarkers and lymphnode metastasis,so as to provide valuable information for the metastasis and prognosis on breast cancer. Methods Computer image analysis was used to investigate the Ki-67,MVD,DNA content and ploidy. Using immunnohistochemical method,the expression of cathepsin-D, hTERT protein,Ki-67,anti-FⅧ-RA was investigated in 90 breast cancers, 28 precancerous diseases and 25 breast benign diseases. Results Ki-67,MVD,DNA content and ploidy(U) increased along with the clinical course of breast benign disease,precancerous disease and breast cancer.Cathepsin-D showed a positive correlation with tumor size,histopathological staging, lymphnode metastasis and ER,PR expressions,but a negative correlation with expression of C-erbB-2;hTERT protein showed a positive correlation with histopathological staging and expression of ER,PR,p53. Conclusion Ki-67 and DNA ploidy can reflect the cell proliferation activity,and indirectly prognose the metastasis of breast cancer.The expression of cathepsin-D is closely linked to lymphnode metastasis and prognosis of breast cancer. MVD that reflects angiogenesis of breast cancer is a important index to lymphnode metastasis.The usage of several biomarkers will improve the accuracy in forecasting the condition of breast cancer.