乳腺浸润性小叶癌组织Ki-67表达与临床病理特征相关性分析

目的 浸润性小叶癌(invasive lobular carcinoma,ILC)组织中Ki-67表达的研究较少,对其预后预测价值尚需进一步文献支持.本研究探讨ILC组织不同临床病理特征下Ki-67表达差异及其与预后的关系.方法 收集天津医科大学肿瘤医院2003-01-10-2012-12-15收治的381例乳腺ILC患者的临床病理资料,分析Ki-67与其临床病理特征的相关性.分析不同年龄、月经状态、体质量指数、家族史、肿瘤大小、淋巴结状态、病理学分期、组织学分型、ER状态、PR状态、HER-2状态和p53状态下,Ki-67表达与预后的关系.结果 381例ILC组织中Ki-67低表达76例(19.9%),中表达91例(23.9%),高表达214例(56.2%).在不同肿物大小(χ2=12.524,P=0.014)、腋窝淋巴结情况(χ2=6.114,P=0.047)、临床分期(χ2=10.434,P=0.034)、ER表达(χ2=6.339,P=0.041)和组织学类型(χ2=78.288,P<0.001)情况下,Ki-67表达差异有统计学意义.Ki-67表达与肿物大小(r=0.168,P=0.001)、腋窝淋巴结情况(r=0.108,P=0.036)、临床分期(r=0.149,P=0.004)和组织学类型(r=0.532,P<0.001)呈正相关.Ki-67表达与ER表达呈负相关,r=-0.112,P=0.029.在肿瘤大小2~5 cm、有腋窝淋巴结转移及临床Ⅱ期ILC组织中,Ki-67表达对患者总生存(overall survival,OS)差异有统计学意义,P<0.05;而对无病生存(disease-free survival,DFS)差异无统计学意义,P>0.05.Cox多因素分析显示,有无淋巴结转移(P=0.000)是ILC总生存的独立预后因素,而肿瘤大小、临床分期和Ki-67表达水平不是影响ILC总生存的独立预后因素,P>0.05.结论 乳腺ILC组织中Ki-67高表达.就诊时肿物越大、有腋窝淋巴结转移和临床分期越高,Ki-67表达水平越高,而ER表达水平越高,Ki-67表达水平越低,肿物大小2~5 cm、有腋窝淋巴结转移及临床Ⅱ期,即中低度恶性ILC组织中Ki-67表达对患者预后有一定的预测价值,但不是独立预后因素,Ki-67对ILC预后预测作用尚需进一步研究.

Analysis between prognosis and expression of Ki-67 with different clinicopathologic features of breast invasive lobular carcinoma

OBJECTIVE There is few research about Ki-67 expression in invasive lobular carcinoma,and its prog-nostic value still needs further literature support.The aim of the study was to analyze the relationship between prognosis and expression of Ki-67 with different clinicopathologic features of ILC.METHODS Clinical data of 381 patients with re-sectable breast ILC in Tianjin Medical University Cancer Institute and Hospital were collected from January 10,2003 to December 15,2012.RESULTS There was 76 cases (19.9%)with Ki-67 low expression,while Ki-67 moderate expression was in 91 cases (23.9%)and Ki-67 high expression was in 214 cases (56.2%)in the whole group of 381 ILC cases.The result showed statistical differences among different Ki-67 expression level regarding tumor size,lymph node metastasis,clinical stage,ER expression and histological classification (P <0.05).There was positive correlation between Ki-67 ex-pression and tumor size(r=0.168,P =0.001),lymph node metastasis(r =0.108,P =0.036),clinical stage(r =0.149, P =0.004)and histological classification(r=0.532,P <0.001).The correlation between Ki-67 expression and ER expres-sion (r=-0.112,P =0.029)was opposite.The expression of Ki-67 in T2 stage ILC,lymph node positive or stage Ⅱ had significant influence on the OS(P <0.05).Multi-factor analysis showed that Ki-67 was not independent pronostic for the overall of patients.CONCLUSIONS Ki-67 is highly expressed in ILC.The large the tumor size,with axillary lymph node invasion and the higher clinical stage,the higher the Ki-67 expression level is.The non-classical ILC has higher Ki-67 ex-pression.The higher the ER expressed,the lower the Ki-67 expression was.Ki-67 expression of ILC with tumor more than 2 cm and less than 5 cm,clinical stage Ⅱand positive lymph node has a significant impact on the survival of patients.Ki-67 has more predictive value for patients with moderate and low-grade malignant ILC.The higher Ki-67 expressed,the worse the prognosis of patients is.