还氧合酶-2在乳腺良恶性病变中的表达及意义

目的 探讨环氧合酶2(COX-2)在乳腺良恶性病变中的表达和分布情况及COX-2表达与乳腺癌临床病理因素、激素受体等的关系.方法 分别对8例副乳腺、31例乳腺良性增生性疾病(BPBD,包括腺病15例,纤维腺瘤16例)、70例浸润性导管癌(IDC),其中35例伴有导管原位癌(DCIS)标本进行COX-2免疫组化标记,观察COX-2在这些组织中的表达情况和分布特征并与C-erbB-2、雌激素受体(ER)、孕激素受体(PR)、临床病理因素等进行对比.结果 ①COX-2表达8例副乳腺全部阴性;BPBD阳性率为96.5%(30/31),其中腺病93.3%(14/15),纤维腺瘤100%(16/16);DCIS阳性率为85.7%(30/35),表达强度≥相应癌组织;IDC阳性率为84.3%(59/70),癌周非癌腺体有不同程度的COX-2表达.②COX-2在BPBD的阳性率明显高于IDC,两者间差异有统计学意义(χ2=9.39,P＜0.025);③COX-2阳性表达在DCIS中与组织分化低(χ2=10.98,P＜0.005)、PR阴性(P=0.019)及C-erbB-2阳性(P=0.0008)有关.在IDC中主要与淋巴结转移(χ2=4.09,P＜0.05)、组织分化低(P=0.004)、PR阴性(χ2=6.91,P＜0.01)及C-erbB-2阳性(χ2=5.94,P＜0.025)等有关.结论 COX-2在正常乳腺组织不表达,在BPBD、DCIS和IDC中均有较高表达,提示COX-2表达上调既参与乳腺致癌,又促进其发展和转移,并可能参与了PR阴性乳腺癌对辅助性内分泌治疗的抵抗性而使治疗反应性下降.

Significance of COX-2 expression in benign and malignant breast diseases

Objective To investigate the expression and distribution of COX-2 in benign and malignant breast disease,and the relationship among COX-2 expression and the clinicopathologic factors,hormone receptors.Methods Immunohistochemistry Was used to investigate the expression and distribution of COX-2 in 8 accessory.breasts,31 BPBDs(15 in adnosis,16 in fibroadnoma),70 IDCs(35 of them accompany with DCIS);The relationships between the expression of COX-2 and hormone receptor(ER and PR),C-erbB-2.and the clinicopathologic factors were studied respectively.Results①The expression of COX-2 in various kinds mammary diseases:8 accessory breasts were all negative;the positive rate of COX-2 in BPBD was 96.5%(30/31),among these,the positive rate of COX-2 in adnosis was 93.3%(14/15),and in fibroadnonm was 100%(16/16).The positive rate of COX-2 in DCIS was 85.7%(30/35).The intensity of COX-2 expression in DCIS of periph-IDC was higher than that in corresponding carcinoma.The positive rate of COX-2 in IDC Was 84.3%(59/70),the expression of COX-2 Was different among non-cancer gland.②COX-2 expression in BPBD was obviously higher compared with COX-2 in IDC,the difference was significant in statistics(χ2=9.39,P＜0.025).③The expression of COX-2 in DCIS was correlative with low histological differentiation(χ2=10.98,P＜0.005),PR negative(P=0.019,Fisher exact probability),and C-erbB-2 positive(P=0.0008,Fisher exact probability).The expression of COX-2 in IDC was correlative with lymph node metastasis(χ2=4.09,P＜0.05),tissue poorly differentiated(P=0.004,Fisher exact probability),PR negative(χ2=6.91,P＜0.01)and C-erbB-2 positive(χ2=5.94,P＜0.025).Conclusion COX-2 does not express in normal mammary gland.It is high-expressed in BPBD,DCIS and IDC;These indicate the up-regulation of COX-2 expression not only participates in breast carcinogenesis,but also promotes its metastasis and progression,and suggests COX-2 may down-regulate reactivity of endocrine thempy by participating in therapy resistance of PR negative breast cancer.