乳腺癌发生发展过程中ER、PR和HER-2变化规律的研究

目的研究雌激素受体(ER)、孕激素受体(PR)和HER-2在乳腺癌前病变-原位癌-微浸润癌-早期浸润性癌过程中的表达情况,探讨它们与乳腺癌发生发展变化的关系。方法收集我院2009年1月～2011年12月经病理学确诊的标本共246例。其中导管上皮普通增生30例,导管上皮不典型增生69例,导管内癌56例,导管内癌伴微浸润31例,I期浸润性导管癌60例。免疫组化采用S-P法。所得数据用t检验和2检验进行统计学分析。结果 ER在普通增生、不典型增生、导管内癌、导管内癌伴微浸润和浸润性导管癌中的阳性表达率分别为60.0%、73.9%、76.8%、51.6%和63.3%,均表现为从导管内癌至微浸润的过程中阳性表达率明显下降,差异有显著性意义(p=0.016和0.017),而在此阶段的前期ER表达虽逐渐增加,但差异无显著性意义(p>0.05)。PR的表达在此阶段的前期和后期均保持在一个相对稳定的水平,差异无显著性意义(p>0.05)。HER-2的阳性表达率分别为3.3%、5.8%、48.2%、54.8%和36.7%,从不典型增生至导管内癌的过程表达明显增加(p<0.001),而在其前期和后期的表达变化均无显著性差异。ER在浸润性导管癌阶段与HER-2的表达呈负相关,其他阶段均无相关性。PR在导管内癌伴微浸润和浸润性导管癌中与HER-2的表达呈负相关,其他阶段亦无相关性。结论 ER表达的逐渐增加是乳腺癌发生的危险因素,而HER-2过表达则是乳腺癌发生的一个重要的启动因子,并通过调节ER/PR信导通路,促其进一步进展为浸润性癌。

THE EXPRESSIONS OF ER,PR AND HER-2 IN THE GENERATING AND DEVELOPMENT OF BREAST CANCER

Objective To investigate the expressions of ER,PR and HER-2 in the generating and development of breast cancer. Methods From January 2009 to December 2011 there were 246 specimens of breast cancer that had confirmed diagnosed by pathology in our hospital.The expressions of ER,PR and HER-2 were examined by immunohistochemical S-P method in 12 cases of papilloma,17 of epithelial atypical hyperplasia(ADH),18 of ductal carcinoma in situ(DCIS),24 of DCIS with microinvasive lesions and 30 of invasive ductal carcinoma(IDC). Results The expressions of ER in papilloma,ADH,DCIS,DCIS with microinvasive lesions and IDC were 60.0%、73.9%、76.8%、51.6% and 63.3%.It showed that the positive expression rate descending markedly in the course from DCIS to microinvasive lesions,the difference had significant meaning(p=0.016 and 0.017).Wile in the prophase of the process the ER expression though increase gradually,but the difference had not significance(p>0.05).The expression of PR in the prophase and post phrase of the process all maintained relative stable level,the difference had no significance(p>0.05).The expressions of HER-2 were 3.3%、5.8%、48.2%、54.8% and 36.7%,It increased significantly in the process from ADH to DCIS(p<0.001) while with no significant difference in other processes.In the phase of intra duct invasion the ER expression and HER-2 expression showed negative correlation but no correlation in the other phases.PR expression in the DCIS with microinvasive lesions and IDC showed negative correlation with HER-2,but non correlation in other phases. Conclusion Increased expression of ER is a risk factor for carcinogenesis of breast cancer.Over-expressions of HER-2 play an important role in the cancerization of breast ductal epithelia.