转移性乳腺癌P 糖蛋白表达与化疗疗效的关系

背景与目的临床研究表明,乳腺癌P 糖蛋白(P glycoprotein,P gp)表达与化疗效果、缓解率、生存期及估计预后有关.但有关P gp表达与乳腺癌转移部位及化疗效果的临床研究报道较少,本研究的目的是探讨乳腺癌P gp表达及其与不同转移部位乳腺癌化疗疗效的关系.方法应用SABC法检测46例转移性乳腺癌术后组织中P gp表达.43例使用联合方案化疗.环磷酰胺600mg/m2ivd1,吡喃阿霉素60mg/m2ivd1,5 氟尿嘧啶600mg/m2ivd1、8,每3周重复,至少2个周期,对比分析P gp表达与疗效的关系.结果P gp阳性表达率56 5%,肝和肺转移者阳性表达明显高于皮肤和淋巴结转移者(P=0 049).可评价疗效的43例患者化疗有效率58 1%,P gp阴性组疗效明显优于P gp阳性组(P<0 01).有肝和肺等内脏转移者有效率明显低于皮肤和浅表淋巴结转移者(P<0 05).术后曾接受辅助性CAF或CMF方案化疗者复发或远处转移后化疗疗效无显著性差异(P>0 05).结论P gp表达可作为评估转移性乳腺癌多药耐药,指导临床用药及判断预后的参考指标.

Influence of P-glycoprotein expression on chemotherapeutic response of metastatic breast carcinoma

Background &Objectives:The clinical study showed that the P glycoprotein(P gp) expression was closely associated with the chemotherapeutic effect, response rate, prognosis, and survival time. Until now, few clinical papers have reported about metastatic sites and its response to chemotherapy with P gp expression in metastatic breast carcinoma. The current study was designed to investigate the role of P gp expression and its clinical value of chemotherapy for the patients with different metastatic sites of this carcinoma. Methods: P gp expression in 46 postoperative patients with metastatic breast carcinoma was detected by SABC immunohistochemical method. 43 cases treated with combination regimen: Cyclophosphamide 600 mg/m2 iv on day 1, Pirarubicin 60 mg/m2 iv on day 1, 5 Fluorouracil 600 mg/m2 iv on days 1 and 8. Repeat the cycle every 3 weeks for at least 2 cycles. The correlation between P gp expression and chemotherapeutic response was analyzed. Results:1) P gp expression positive rate was 56 5%, the P gp expression in the patients with lung or liver viscera metastasis was higher than that in skin or lymph node metastasis (P=0 049). 2)The overall response rate was 58 1%in 43 patients.The response rate of the P gp negative group was higher than the P gp positive group(P< 0 01). 3) The response rate in the patients with skin and lymph node metastasis was higher than the patients with lung and liver metastasis (P< 0 05). 4)The postoperative patients who had received CAF(cyclophosphamide+adriamycin+5 fluorouracil) or CMF(cyclophosphamide+methotrexate+5 fluorouracil) regimen adjuvant chemotherapy previously, the response rate of metastatic diseases to chemotherapy had no significant difference (P >0 05). Conclusions:P gp expression may be considered as an index for evaluating multidrug resistance, guiding drug use, and judging prognosis of the patients with metastatic breast carcinoma.