上皮细胞黏附分子表达与乳腺癌的分子分型及预后

目的：探讨上皮细胞黏附分子(epithelial cell adhesion molecule，EpCAM)在乳腺癌及其分子亚型中表达的临床病理及预后意义。方法：采用免疫组织化学MaxVisionTM法检测835例乳腺浸润性导管癌中EpCAM的表达，分析其与临床病理特征和预后的关系。结果：EpCAM的阳性表达与组织学分级、淋巴结转移、肿瘤大小、ER和PR表达、HER2表达和临床分期均有关(均P<0.05)，与绝经状态无关(χ2=0.117，P=0.733)。在腺腔A型、腺腔B型(HER2−)、腺腔B型(HER2+)、HER2过表达型及三阴型乳腺浸润性导管癌(invasive ductal carcinoma，IDC)中， EpCAM的阳性表达率分别为19.2%，73.0%，48.9%，72.2%和62.1%。Log-rank检验和单因素COX分析显示EpCAM阳性患者的预后较差(均P<0.001)，并与三阴型、腺腔B型(HER2−)和HER2过表达型预后有关(均P<0.05)。多因素COX分析显示EpCAM阳性表达与三阴型和HER2过表达型预后差相关(均P<0.05)。结论：EpCAM可能与乳腺癌进展有关，并与分子分型相关，在乳腺癌总体上及三阴型和HER2过表达型中是一种独立的预后因子。

Expression of epithelial cell adhesion molecule and molecular subtypes and prognosis of breast cancer

Objective: To investigate clinicopathological and prognostic significance of epithelial cell adhesion molecule (EpCAM) expression in breast cancer and its molecular subtypes.Methods: The expression of EpCAM in 835 patients with breast invasive ductal carcinoma was detected by immunohistochemical Max VisionTM method, and its correlation with clinical pathological features and prognosis was analyzed.Results: The positive expression of EpCAM was related to histological grade, lymph node metastasis, tumor size, clinical stage, the expression of estrogen receptor (ER), progesterone receptor (PR) and HER2 (P<0.05). The positive expression rates of EpCAM were 19.2%, 73%, 48.9%, 72.2%, and 62.1%, in Luminal A, Luminal B (HER2−), Luminal B(HER2+), HER2+, and triple-negative subtype, respectively. Log-rank test and univariate COX analysis showed that the EpCAM expression was associated with a poor prognosis in all patients (P<0.001), as well as the triple-negative subtype, luminal B subtype (HER2−), and HER2+ subtype (P<0.05). Multivariate COX analysis showed that EpCAM expression was associated with the survival in patients with the triple-negative or HER2+ subtype (P<0.05).Conclusion: EpCAM may be associated with progress of breast cancer. It is an independent prognostic factor in breast cancer, especially in the triple-negative and HER2+ subtypes.