Luminal 型乳腺癌 P53表达与临床病理特征及预后的关系

目的：探讨 Luminal 型乳腺癌 P53表达与临床病理特征及预后的关系。方法选取2009年1月至2012年12月在上海交通大学附属第一人民医院手术治疗的283例 Luminal 型乳腺癌患者作为研究对象，采用免疫组织化学法测定 P53表达。生存分析采用 Kaplan-Meier 曲线评估和 Log-rank 检验比较，并用 Cox 比例风险回归模型进行单因素和多因素分析。结果 Luminal 型乳腺癌患者 P53表达与肿瘤最大径（χ2＝6．285，P ＝0．043）、淋巴结转移（χ2＝15．881，P ＝0．000）、组织分级（χ2＝8．132，P ＝0．043）、Ki-67（χ2＝6．476，P ＝0．039）有关；而与年龄（χ2＝0．955，P ＝0．328）、月经状态（χ2＝3．808，P ＝0．051）、病理类型（χ2＝0．847，P ＝0．655）、雌激素受体（χ2＝1．867，P ＝0．172）、孕激素受体（χ2＝0．937， P ＝0．333）及人表皮生长因子受体-2（χ2＝0．110，P ＝0．741）无关。在283例患者中，P53阴性组和阳性组5年无复发生存率分别为90．7％、66．7％（χ2＝12．609，P ＝0．000），5年总生存率分别为93．4％、84．4％（χ2＝4．153，P ＝0．042），差异均有统计学意义。Cox 多因素分析发现，淋巴结转移（HR ＝2．484，95％CI 为1．393～4．431，χ2＝9．497，P ＝0．002）和 P53阳性（HR ＝3．627，95％CI 为1．061～12．401；χ2＝4．220，P ＝0．040）是 Luminal 型乳腺癌患者无复发生存的独立危险因素；淋巴结转移（HR ＝3．451，95％CI为1．891～6．297；χ2＝16．290，P ＝0．000）和高组织学分级（HR ＝2．806，95％CI 为1．091～7．219；χ2＝4．582，P ＝0．032）是总生存时间的独立危险因素。结论 Luminal 型乳腺癌患者 P53过表达与淋巴结转移、组织分级等预后因素相关，且 P53过表达患者预后更差。

Correlations between P53 expression and clinicopathologic factors and the prognosis of Luminal breast cancer

Objective To investigate the correlations between P53 expression and clinicopathologic factors and prognosis of Luminal breast cancer.Methods From January 2009 to December 2012,a total of 283 patients with Luminal breast cancer in the Shanghai General Hospital Affiliated to Shanghai Jiaotong Univer-sity were included.P53 expressions of them were assayed by immunohistochemistry.Survival analysis was applied using Kaplan-Meier curve and Log-rank test.Single factor analysis and mutiple-factor analysis were applied using Cox proportional hazard regression model.Results The rate of P53 expression was associated with tumor size (χ2 =6.285,P =0.043),lymph node metastasis (χ2 =15.881,P =0.000),histological grade (χ2 =8.132,P =0.043)and Ki-67 (χ2 =6.476,P =0.039),but it was not associated with age (χ2 =0.955,P =0.328),menopausal status (χ2 =3.808,P =0.051),pathological pattern (χ2 =0.847,P =0.655),estrogen receptor (χ2 =1.867,P =0.172),progesterone receptor (χ2 =0.937,P =0.333)and human epidermal growth factor receptor-2 (χ2 =0.110,P =0.741 ).In all the 283 patients,the 5-year relapse-free survival rates for P53-positive group and P53-negative group were 66.7% and 90.7% respectively (χ2 =12.609,P =0.000),while the 5-year overall survival rates were 84.4% and 93.4% respectively (χ2 =4.153,P =0.042),with significant differences.In Cox mutiple-factor analysis,lymph node metastasis (HR =2.484,95%CI:1.393-4.431,χ2 =9.497,P =0.002)and P53 over-expression (HR =3.627,95%CI:1.061-12.401,χ2 =4.220,P =0.040)were independent prognostic factors for the relapse-free survival of patients with Luminal breast cancer,and lymph node metastasis (HR =3.451,95%CI:1.891-6.297,χ2 =16.290,P =0.000)and higher histological grade (HR =2.806,95%CI:1.091-7.219,χ2 =4.582,P =0.032)were independent prognostic factors for overall survival.Conclusion P53 over-expression of patients with Luminal breast cancer is associated with prognostic factors such as lymph node metastasis and histological grade,which indicates the worse prognosis.