乳腺癌淋巴结转移相关因素的多元分析

目的通过对Ki-67标记指数、DNA含量及倍体情况、微血管密度(MVD)、组织蛋白酶D(Cathepsin-D)、端粒酶(hTERT)在乳腺癌中的表达,结合乳腺癌肿瘤大小、组织学分级及雌激素受体(ER)、孕激素受体(PR)、p53、CerbB-2等的表达,进一步明确各指标与乳腺癌淋巴结转移的关系,为预后提供有价值的信息。方法用图像分析系统对Ki-67、MVD及DNA含量进行定量检测;用免疫组织化学S-P法检测乳腺癌、乳腺癌前病变及良性病变中Cathepsin-D、hTERT基因蛋白、Ki-67、抗FⅧ-RA的表达;选择10项可能影响乳腺癌淋巴结转移的相关因素进行量化,应用SPSS 10.0统计软件包多因素Logistic逐步回归分析。结果Ki-67标记指数、MVD、细胞DNA相对倍体均值(U值)按乳腺良性病变、乳腺癌前病变及乳腺癌的顺序呈递增趋势,且随乳腺癌分级的增高而显著增高。Cathepsin-D与肿瘤大小、组织学分级、淋巴结转移、ER、PR呈正相关(P<0.05),与CerbB-2呈负相关(P<0.05);hTERT在乳腺癌与癌前病变组,乳腺癌与良性病变组间差异有统计学意义(P<0.05),与组织学分级ER、PR、p53表达呈正相关(P<0.05)。经多因素Logistic逐步回归分析,与淋巴结转移密切相关的因素为:肿瘤大小、组织学分级、MVD、Cathepsin-D。结论乳腺癌肿瘤大小及病理组织学分级仍然是判断乳腺癌淋巴结转移和预后的密切相关因素。多种指标的联合应用有助于提高乳腺癌预后预测的正确性。

A multivariate analysis of clinicopathologic factors in lymphatic metastasis of breast cancer

Objective To explore Ki-67 LI,MVD,DNA expression and ploidy,and Cathepsin-D and hTERT protein expression in breast cancer,combining the expression of ER,PR,p53,C-erbB-2 and tumor size,and histological grading;to make clear the relationship between the biomarkers of lymphnode metastasis and to provide the valuable information of lymphnode metastasis and prognosis in breast cancer.Methods Computer image analysis was used to investigate the Ki-67 LI,MVD and DNA expression and ploidy.Using immunnohistochemical method,the expression of cathepsin-D,hTERT gene,Ki-67 and FⅧ-RA was detected and investigated in 90 cases of breast cancer,28 precancerous disease and 25 breast benign disease.Logistic stepwise regression method was used to analyze the influence of 10 clinicopathological factors linking to lymphnode metastasis.Results Ki-67 LI,MVD and DNA cytometry and ploidy (U) were increased with breast benign diseases,precancerous diseases and breast cancer,Cathepsin-D showed positive correlation with tumor size,histopathology,lymphnode metastasis and expression of ER and showed PR,negative correlation with expression of C-erbB-2;hTERT protein showed positive correlation with histopathological and expression of ER,PR and p53;In 10 clinicopathological factors,the factors closely involved in lymphnode metatasis were tumor size,histopathologicy,MVD and Cathepsin-D.Conclusion Tumor size and histological grading are highly involved in the lymphnode metatasis and prognosis of breast cancer.The use of several biomarkers will improve the rightness for forecasting the prognosis of breast cancer.