乳腺癌外周血CK-19mRNA的表达及临床意义

目的：研究外周血CK-19 mRNA表达与乳腺癌临床生物学指标的关系,探讨其作为乳腺癌微转移标志物的可能性,并判断手术和化疗对血液微转移的影响。方法：应用RT-PCR技术检测50例乳腺癌患者（乳腺癌组）术前、术后第2天、第1次化疗结束后以及术后9～12个月外周血中CK-19 mRNA的表达情况,并以20例乳腺良性疾病（良性对照组）和20例正常健康女性（正常对照组）作为对照。结果：术前乳腺癌组外周血CK-19 mRNA阳性率为24.00%（12/50）,其中0～Ⅰ期15.38%（2/13）Ⅰ,Ⅰ期20%（6/30）Ⅰ,Ⅱ期57.14%（4/7）Ⅰ,Ⅱ期乳腺癌CK-19 mRNA阳性表达率明显高于0～Ⅱ、Ⅰ期（P〈0.05）;有淋巴结转移者42.11%（8/19）表达阳性,无淋巴结转移者12.94%（4/31）表达阳性,二者差异有统计学意义（P〈0.05）。良性疾病组CK-19 mRNA的阳性率为5.00%（1/20）,正常对照组均阴性,乳腺癌组与良性疾病组和正常对照组比较差异有统计学意义（P均〈0.01）。乳腺癌组术后第2天CK-19 mRNA阳性率为26%（13/50）,与术前比较差异无统计学意义（P〉0.05）。术后首次化疗结束后CK-19 mRNA阳性率为12%（6/50）,化疗前后差异有统计学意义（P〈0.01）。综合治疗9～12个月后CK-19 mRNA阳性率为10%（5/50）,与术前比较差异有统计学意义（P〈0.01）。外周血CK-19 mRNA阳性率与雌激素受体（ER）、孕激素受体（PR）、CerbB2、p53状态无关。结论：CK-19 mRNA可作为检测乳腺癌患者外周血微转移的分子学标志物,有助于早期预测乳腺癌发生血道微转移,对指导治疗和评估预后具有重要意义。

Expression and clinical significance of peripheral blood micro metastasis in patients with breast cancer

Objective： To study the relationship between expression of CK-19 mRNA in peripheral blood and biological characteristics of breast cancer,and evaluate its clinical significance,to explore the effects of operation and postoperative chemotherapy on micro metastasis in breast cancer.Method： The CK-19 mRNA in the peripheral blood of 50 cases with breast cancer was tested with RT-PCR method before operation,on the 2nd day after operation,the last of the first course of postoperative chemotherapy and 9~12 months after receiving comprehensive treatment.Twenty patients with benign breast disease and 20 healthy women were taken as control.Results： The positive rates of CK-19 mRNA in patients with breast cancer were 24.00%（12/50）.The positive rate at 0~I,Ⅱ and Ⅲ stages were 15.38%（2/13）,20.00%（4/20）and 57.14%（4/7）,respectively.There was significant difference in positive rate between Ⅲ stage and 0~I、Ⅱ stages（P0.05）.The positive rates of CK-19 mRNA in patients with and without lymph nod metastasis were 42.11%（8/19） and 12.94%（4/31）respectively（P0.05）.The positive rates of CK-19 mRNA in benign breast diseases were 5.00%（1/20）.CK-19 mRNA was all negative in the 20 healthy women.The difference of the positive rate between the group with breast cancer and the control group was significant（P0.01）. The positive rates of CK-19 mRNA on the second day after operation was 26.00%（13/50）.There was no significant difference in positive rate of CK-19 mRNA expression in blood between preoperation and the second day after operation（P0.05）.The positive rates of CK-19 mRNA expression on the last day of the first postoperative chemotherapy course was 12.00%（6/50）.Postoperative chemotherapy showed a significant influence on the CK-19 mRNA expression（P0.01）.The positive rates of CK-19 mRNA was significantly different（P0.01）between the results of preoperation and after comprehensive treatment for 9~12 months10.00%（5/50）.There was no significant difference for types of ER,PR,CerbB2 and P53.Conclusion： CK-19 mRNA can be used as a molecular marker in peripheral blood by method of RT-PCR for the detection of breast cancer.It would be useful for the early prediction on the micro metastasis of the breast cancer,and it can provide important information for estimating prognosis and guiding clinical therapy of breast cancer.