【摘要】：背景與目的乳腺癌是現(xiàn)代女性最常見的腫瘤,近年來乳腺癌的發(fā)病率在逐年上升。腫瘤分子生物學(xué)技術(shù)的不斷發(fā)展證實(shí),腫瘤的發(fā)生和轉(zhuǎn)移是一個(gè)多因素的復(fù)雜過程。近年來在對(duì)乳腺癌生物學(xué)特點(diǎn)的不斷研究中發(fā)現(xiàn)影響乳腺癌預(yù)后的一個(gè)重要因素為人類表皮生長因子受體(HER-2)。在臨床治療中發(fā)現(xiàn)HER-2基因擴(kuò)增乳腺癌患者復(fù)發(fā)轉(zhuǎn)移率高,生存期較短,預(yù)后相對(duì)較差。HER-2基因與其他分子生物學(xué)特征之間的關(guān)系是國內(nèi)外研究的熱點(diǎn),HER-2基因擴(kuò)增或過表達(dá)與腫瘤組織學(xué)特征和其他分子生物學(xué)指標(biāo)的相關(guān)性研究中,發(fā)現(xiàn)HER-2基因與其他生物學(xué)指標(biāo)如腫瘤大小、組織學(xué)分級(jí)、淋巴結(jié)轉(zhuǎn)移情況、ER表達(dá)等之間的關(guān)系,結(jié)果存在較大差異甚至出現(xiàn)相反結(jié)果。這與檢測(cè)方法和評(píng)判標(biāo)準(zhǔn)以及入組標(biāo)準(zhǔn)的不同有很大關(guān)系。在不同研究中結(jié)果有所不同,難以準(zhǔn)確的反應(yīng)真實(shí)的乳腺癌HER-2基因表達(dá)的特點(diǎn),不利于指導(dǎo)臨床的治療。本文通過免疫組化和熒光原位雜交技術(shù)聯(lián)合檢測(cè)HER-2基因狀態(tài),嚴(yán)格遵循指南要求的判讀標(biāo)準(zhǔn)。分析研究了HER-2基因擴(kuò)增和過表達(dá)乳腺癌患者的臨床特點(diǎn)以及與其他臨床病理特點(diǎn)的關(guān)系,對(duì)進(jìn)一步認(rèn)識(shí)HER-2基因在乳腺癌中的表達(dá)及臨床的治療有指導(dǎo)意義。方法收集了2013年12月至2017年3月于我院行乳腺癌術(shù)后標(biāo)本363例,所有標(biāo)本均經(jīng)病理證實(shí)為乳腺浸潤性導(dǎo)管癌。先經(jīng)過免疫組化法(IHC)檢測(cè)標(biāo)本,對(duì)于HER-2不確定的標(biāo)本在進(jìn)行熒光原位雜交(FISH)方法檢測(cè)。根據(jù)免疫組化和FISH檢測(cè)把患者分為HER-2表達(dá)組和不表達(dá)組,表達(dá)組包括HER-2過表達(dá)(+++)、FISH結(jié)果陽性;不表達(dá)組包括HER-2(-、+)、FISH結(jié)果陰性。同時(shí)收集患者年齡、腫塊大小、淋巴結(jié)轉(zhuǎn)移情況等臨床資料。分析HER-2基因表達(dá)乳腺癌患者臨床特點(diǎn),以及兩組患者之間各因素之間的關(guān)系。應(yīng)用SPSS17.0軟件包,資料分析時(shí)采用卡方(χ2)檢驗(yàn),相關(guān)性分析采Spearman相關(guān)分析,以α=0.05為檢驗(yàn)水準(zhǔn)。結(jié)果1.363例乳腺癌患者組織標(biāo)本中HER-2不表達(dá)組有304例,占83.7%。表達(dá)組有59例,比例占16.3%。2.單因素分析結(jié)果顯示:HER-2表達(dá)組和不表達(dá)組在淋巴結(jié)轉(zhuǎn)移(59.3%vs38.5%)、ER陽性表達(dá)(74.6%vs87.2%)、組織學(xué)分級(jí)(20.3%vs28.3%;64.4%vs63.1%;15.3%vs8.6%)、Ki-67≥14%比率(91.5%vs74.0%)四個(gè)因素之間差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。3.相關(guān)性分析結(jié)果顯示:HER-2表達(dá)組和不表達(dá)組在淋巴結(jié)轉(zhuǎn)移、組織學(xué)分級(jí)、Ki-67這三項(xiàng)因素與HER-2表達(dá)呈正相關(guān)(r1=0.28、r2=0.45、r3=0.34、p0.05);在ER表達(dá)上呈負(fù)相關(guān)(r1=-0.38,p0.05)。結(jié)論1.HER-2陽性乳腺癌患者HER-2基因表達(dá)與淋巴結(jié)轉(zhuǎn)移、ER、組織學(xué)分級(jí)、KI-67之間有相關(guān)性。
[Abstract]:Background & objective Breast cancer is the most common tumor in modern women. The incidence of breast cancer is increasing year by year in recent years. With the development of tumor molecular biology technology, the occurrence and metastasis of tumor is a complex process of many factors. Human epidermal growth factor receptor (HER-2) has been found to be an important factor in the prognosis of breast cancer in recent years. In clinical treatment, it was found that the recurrence and metastasis rate of breast cancer with HER-2 gene amplification was high, the survival time was shorter, and the prognosis was relatively poor. The relationship between HER-2 gene and other molecular biological characteristics was a hot topic at home and abroad. In the study of the correlation between the amplification or overexpression of HER-2 gene and tumor histological features and other molecular biological indexes, it was found that HER-2 gene was associated with other biological parameters such as tumor size, histological grade, lymph node metastasis. The relationship between the expression of ER and so on, the result has the big difference even appears the opposite result. This has much to do with the difference between the detection method, the evaluation criteria and the group entry criteria. The results of different studies are different, and it is difficult to accurately reflect the true characteristics of HER-2 gene expression in breast cancer, which is not conducive to guiding clinical treatment. The status of HER-2 gene was detected by immunohistochemistry and fluorescence in situ hybridization (Fish), and the standard of interpretation was strictly followed. The clinical characteristics of breast cancer patients with amplification and overexpression of HER-2 gene and their relationship with other clinicopathological features were analyzed and studied. It is of guiding significance to further understand the expression of HER-2 gene in breast cancer and its clinical treatment. Methods 363 cases of breast cancer were collected from December 2013 to March 2017 in our hospital. All specimens were pathologically confirmed as invasive ductal carcinoma of the breast. The samples were detected by immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) for uncertain HER-2 samples. The patients were divided into HER-2 expression group and non-expression group according to immunohistochemistry and FISH detection. The expression group included HER-2 overexpression (), FISH positive group and non-expression group including HER-2 (-,), FISH result negative result). At the same time, the patient's age, tumor size, lymph node metastasis and other clinical data were collected. To analyze the clinical characteristics of breast cancer patients with HER-2 gene expression and the relationship between the two groups. The data were analyzed by chi-square test (蠂 ~ 2) and correlation analysis by Spearman correlation analysis with 偽 = 0. 05 as the test level. Results there were 304 cases (83.7%) in HER-2 negative expression group in 1.363 cases of breast cancer. There were 59 cases in the expression group, accounting for 16.3%. 2. Univariate analysis showed that the positive expression of), ER (74.6 vs 87.2%) in lymph node metastasis (59.3 vs 38.5%) and histologic grade (20.3vs28.3g) in HER-2 expression group and non-expression group; There were significant differences among the four factors (Ki-67 鈮，

本文編號(hào)：2296377