淋巴结阴性乳腺癌p21~(waf1)、c-erbB-2和p53蛋白表达及其临床意义

目的：探讨腋淋巴结阴性乳腺癌组织中ｐ２１ｗａｆ１、ｃ－ｅｒｂＢ－２和ｐ５３基因蛋白表达及其与临床病理参数和预后的关系。方法：应用免疫组化ＬＳＡＢ方法检测１２１例腋淋巴结阴性乳腺癌石蜡切片中ｐ２１ｗａｆ１、ｃ－ｅｒｂＢ－２和ｐ５３蛋白的表达情况；同时应用Ｋａｐｌａｎ－Ｍｅｉｅｒ法及多变量Ｃｏｘ比例风险模型，分析３种蛋白表达与预后的关系。结果：（１）ｐ２１ｗａｆ１蛋白表达率为 ４８． ８％，与病理组织学分级、ＥＲ状态有关； ｐ５３蛋白表达率为 ３６． ４％， ｃ－ｅｒｂＢ－２蛋白表达率为 ２６． ４％，与组织学分级有关；（２）ｐ２１ｗａｆ１阳性表达与 ｐ５３表达呈负相关（ Ｐ＜ ０． ０５）；（３）ｐ２１ｗａｆ１阳性组患者无瘤生存率高于阴性组（Ｐ＜０．０５）；ｃ－ｅｒｂＢ－２阳性组患者无瘤生存率明显低于阴性组（Ｐ＜０ ０１）；Ｃｏｘ模型分析显示仅有ｃ－ｅｒｂＢ－２表达对预后有显著影响。结论：乳腺癌组织ｐ２１ｗａｆ１、ｃ－ｅｒｂＢ－２表达与病理组织学分级有相关性；ｐ２１ｗａｆ１表达依赖于ｐ５３途径刺激； ｐ２１ｗａｆ１、、ｃ－ｅｒｂＢ－２表达与腋淋巴结阴性乳腺癌预后有关，且ｃ－ｅｒｂＢ－２表达是一个独立的预后指标。

Expression of p21~(waf1), c-erbB-2, and p53 Genes in Node-Negative Breast Carcinoma and Their Clinical Significance

Objective: The aim of this study was to determine the expression of p21waf1, c-erbB-2, and p53 in node-negative breast cancer in relation to the clinicopathological parameters and prognosis. Methods: Expression of p21waf1, c-erbB-2 and p53 in 121 patients were determined by LSAB immunohistochemical method, and Kaplan-Meter method and Cox proportional hazard model were used to analyze the relationship of their expressions with prognosis. Results: (1) The expression rate of p21waf1 was 48. 8% , and was in connection with histological grade and ER-positive. (2 ) The expression rate of p53 and c-erbB-2 was 36. 4% and 26. 4% respectively. C-erbB-2 positive expression was associated with histological grade. (3 ) the expression of p21waf1 was inversely correlated with that of p53 protein (P < 0. 05 ). (4) the results of survival analysis with Kaplan-Meter method showed that better disease-free survival(DFS) in the patients with p21waf1 expression than those without, the negative c-erbB-2 expression exhibited a significantly better prognosis than positive c-erbB-2 expression (P < 0. 01 ). Conclusions: There was a significant correlation between the expression of p21waf1, c-erbB-2, and tumor grade; a p53-indenpent pathway can mainly induce the expression of p21waf1; p21waf1 expression was a good prognostic marker for the patients with node-negative breast cancer; c-erbB- 2 positive expression was an independent prognostic marker.