受体三阴性乳腺癌中基底细胞角蛋白的表达及其与预后的关系

目的 研究受体三阴性乳腺癌组织中基底细胞角蛋白(CK5/6和CKl7)的表达情况,探讨其与患者临床病理特征及预后之间的关系.方法 2000年1月至2002年12月在复旦大学附属肿瘤医院接受手术治疗,有完整随访资料且免疫组织化学检测为受体三阴性的乳腺癌患者112例,将112例原发灶石蜡切片用EnVision二步法进行CK5/6和CK17免疫组织化学染色,检测CK5/6和CK17的表达.结果 全组患者的5年无复发生存率为73.2%(82/112).CK5/6和CK17均为阳性的患者占21.4%(24/112),CK5/6和(或)CK17阳性(即CKs阳性)者占46.4%(52/112).CK5/6、CK17和CKs阳性患者的5年无复发生存率均低于其对应的阴性患者(P=0.020,P=0.032,P=0.003);CK5/6和CKs阳性患者的5年总生存率亦低于其对应的阴性患者(P=0.027,P=0.015).CKs阳性患者与CK5/6和CK17阴性(即CKs阴性)患者比较,组织学分级为Ⅲ级的患者所占的比例以及腋窝淋巴结转移之间的差异有统计学意义(P=0.030,P=0.044).多因素分析显示,组织学分级、病理分期以及CK5/6的表达均为5年无复发生存率和总生存率的独立影响因素,月经状态为5年无复发生存率的独立影响因素.结论 CK5/6和CK17的表达与肿瘤的组织学分级以及腋窝淋巴结的转移状态相关,且阳性表达患者的预后较差.

Expression of CK5/6 and CK17 and its correlation with prognosis of triple-negative breast cancer patients

Objective To investigate the correlation of CK5/6 and CK17 expression with clinical outcome in patients with triple-negative[ER(-),PR(-),Her-2(-)]breast cancer.Methods 112 patients with breast cancer treated by surgery between 2000 and 2002 were included in this study.All cases were immunohistochemically proven to be triple-negative.Sampies of formalin-fixed and paraffin-embedded surgical specimens were obtained for immunohistological examination for CK5/6 and CK17 expression.The correlation of the gene expression with clinicopathological features and outcome of the patients was analyzed.Results Of the 112 triple-negative patients,five-year disease-free survival rate was 73.2%(82/112).The positive rate of both CK5/6 and CK17 was 21.4%(24/112),either CK5/6 or CK17 positive waa 46.4%(52/112).It was shown by Kaplan-Meier curve that positive CK5/6.CK17 or CKs(CK5/6 or CK17 positive)was correlated with poor five-year disease-free survival(P=0.020,P=0.032,P=0.003);and positive staining of CK5/6 or CKs was correlated with poor five-year overall survival(P=0.027,P=0.015).Of the 91 patients with invasive ductal carcinoma.a correlation of CK5/6 or CK17 positive staining with high grade differentiation was observed(P=0.030),and with axillary lymph node metastasis was also noticed(P=0.044).Multivariate analysis by Cox regression showed that differentiation grade,pathological stage and expression of CK5/6 were factors affecting both the disease-free-survival and overall-survival.while menopausal status was an independent factor affecting the disease-free-survival.Conclusion Positive expression of CK5/6 or CK17 in patients with triple-negative breast cancer is correlated with poor prognosis,high grade differentiation and axillary lymph node metastasis.