EGFR和survivin對乳腺癌新輔助化療療效的預(yù)測價值
發(fā)布時間：2019-01-03 14:30
【摘要】：背景與目的乳腺癌是臨床上女性最常見到的惡性腫瘤之一,目前已達(dá)到女性惡性腫瘤發(fā)病率的第一位[1],并且在一年一年的增加,每年新確診的乳腺癌患者在女性惡性腫瘤中占相當(dāng)大的比例,約60萬人發(fā)生死亡事件,西方發(fā)達(dá)國家女性乳腺癌發(fā)病率高[2]。近年來,隨著生活方式逐漸向高蛋白、高熱量、高脂肪的生活方式轉(zhuǎn)化,在我國特別是東部發(fā)達(dá)地區(qū),乳腺癌的發(fā)病率已接近世界水平,嚴(yán)重危害了廣大女性的健康[3]。雖然發(fā)病率維持在很高的水平,死亡率卻沒有增加,反而表現(xiàn)為下降,這獲益于乳腺癌診斷和醫(yī)治方式的一直提高,最大的成就就是新輔助化療的實施[4]。新輔助化療就是在惡性腫瘤還沒有發(fā)生轉(zhuǎn)移的時候,趕在行乳腺癌根治術(shù)和/或局部放療之前,先給予細(xì)胞毒性藥物給予全身治療的化療方法[5]。新輔助化療排除了輔助化療的許多劣勢,可以降低原發(fā)腫塊的體積,使乳腺癌患者的臨床分期下降,使不能手術(shù)切除或者不能完全切除的病灶得到根治,并可檢測化療方案的可行性[6]。由于新輔助化療方案眾多,在選擇化療方案的時候,需要結(jié)合患者實際情況選擇不同有針對性的方案[7]。因此,新輔助化療療效的預(yù)測因子應(yīng)運而生,以后可能會一直成為人們研究的重點[8]。EGFR是人類最常見的表皮生長因子受體,survivin是近些年新發(fā)現(xiàn)的凋亡抑制蛋白家族成員[9]。本課題搜集鄭大一附屬醫(yī)院乳腺外科診療的乳腺癌及其癌旁正常乳腺標(biāo)本各80例,這些患者都做過EGFR和survivin的免疫組化,探究EGFR和survivin對新輔助化療療效的預(yù)示能力[10]。方法按照入組標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),搜集2015年8月至2016年8月經(jīng)我科診療的乳腺癌及其癌旁正常乳腺標(biāo)本各80例,這些患者都做過EGFR和survivin的免疫組化,運用與統(tǒng)計學(xué)統(tǒng)計標(biāo)本中EGFR、survivin的狀況,并剖析這些因子與患者年齡、腫瘤體積、組織水平分級、臨床分期及淋巴結(jié)有無轉(zhuǎn)移之間的關(guān)系,以及分析其與乳腺癌預(yù)后之間的關(guān)系。結(jié)果1.EGFR在乳腺癌組織中的的陽性表達(dá)率為68.8%(55/80),顯著高于癌旁正常乳腺組織中的陽性率33.8%(27/80),差異具有統(tǒng)計學(xué)意義(P0.05)。survivin在乳腺癌組織的陽性率為72.5%(58/80),高于癌旁組織的陽性表達(dá)率27.5%(22/80),差異具有統(tǒng)計學(xué)意義(P0.05)。2.乳腺癌組織中EGFR的表達(dá)水平與腫瘤大小、組織學(xué)分級、臨床分期、淋巴結(jié)轉(zhuǎn)移相關(guān)(P0.05),乳腺癌中Survivin表達(dá)水平與淋巴結(jié)轉(zhuǎn)移相關(guān)(P0.05),與腫瘤體積大小、組織學(xué)分級水平、臨床分期沒有關(guān)系(P0.05),這兩種腫瘤生物學(xué)標(biāo)志物表達(dá)與患者年齡沒有關(guān)系(P0.05)。3.所有患者,在EGFR低表達(dá)組,58例患者達(dá)到p CR、c CR和PR,高表達(dá)組9例達(dá)到p CR、c CR和PR,EGFR低表達(dá)組的臨床總有效率(p CR、c CR和PR)明顯高于EGFR高表達(dá)組(95.08%VS 47.37%P=0.000);49例survivin低表達(dá)組達(dá)到p CR、c CR和PR,survivin高表達(dá)組14例達(dá)到p CR、c CR和PR,survivin低表達(dá)組的臨床總有效率(p CR、c CR和PR)明顯高于高表達(dá)組(85.96%VS 60.87%P=0.013)。結(jié)論1.EGFR和survivin在乳腺癌組織中表達(dá)的水平高于癌旁正常乳腺組織(P0.05)。2.乳腺癌組織中EGFR的表達(dá)水平與腫瘤大小、組織學(xué)分級、臨床分期、淋巴結(jié)轉(zhuǎn)移相關(guān)(P0.05),乳腺癌中survivin表達(dá)水平與淋巴結(jié)轉(zhuǎn)移相關(guān)(P0.05),與腫瘤大小、組織學(xué)分級、臨床分期無關(guān)(P0.05),二者均與年齡無關(guān)(P0.05)。3.EGFR和survivin的表達(dá)程度高低可能是乳腺癌新輔助化療療效的一個有效預(yù)測指標(biāo)。
[Abstract]:Background and target breast cancer is one of the most common malignant tumors in the world, and has reached the first[1] of the incidence of female malignant tumor, and the newly diagnosed breast cancer accounts for a considerable proportion of the female malignant tumor every year in an increase of one year. About 600,000 people have died, and the incidence of breast cancer in the western developed countries is high[2]. In recent years, with the lifestyle of high-protein, high-calorie and high-fat life, the incidence of breast cancer has been close to the world level in our country, especially in the developed region of the east, seriously endangering the health of the general female[3]. Although the rate of morbidity is maintained at a high level, the mortality rate has not increased, but rather a decline, which has benefited from the ongoing improvement in the diagnosis and treatment of breast cancer, with the greatest achievement being the implementation of the new adjuvant chemotherapy[4]. The neoadjuvant chemotherapy is a method of chemotherapy for systemic treatment of the cytotoxic drug prior to the radical mastectomy and/ or local radiotherapy of the breast cancer in the absence of metastasis in the malignant tumor. The new adjuvant chemotherapy eliminates many of the disadvantages of the adjuvant chemotherapy, can reduce the volume of the primary mass, and lead the clinical stage of the breast cancer patient to be reduced, so that the lesion which cannot be operated or cannot be completely cut can be radically cured, and the feasibility of the chemotherapy scheme can be detected[6]. Due to the large number of new adjuvant chemotherapy regimens, it is necessary to select different targeted solutions in combination with the patient's actual situation when selecting a chemotherapy regimen[7]. Therefore, the prediction factor of the new adjuvant chemotherapy has come into being, and it may be the focus of the people's research. EGFR is the most common epidermal growth factor receptor in humans, and survivin is a newly discovered member of the apoptosis-inhibiting protein family in recent years[9]. In this study, 80 cases of breast cancer and the normal breast specimens were collected in the breast surgery of the Affiliated Hospital of Zheng's First Affiliated Hospital. The expressions of EGFR and survivin were used to study the predictive ability of EGFR and survivin in the treatment of neoadjuvant chemotherapy[10]. Methods 80 cases of breast cancer and other normal breast specimens from August 2015 to August 2016 were collected from August 2015 to August 2016 according to the standard and exclusion criteria of the group. The relationship between these factors and the patient's age, tumor volume, tissue level, clinical stage and lymph node metastasis was analyzed, and the relationship between these factors and the prognosis of breast cancer was analyzed. Results 1. The positive expression rate of EGFR in breast cancer tissues was 68. 8% (55/ 80). The positive rate of survivin in the normal breast tissue was 32.8% (27/ 80). The positive rate of survivin in breast cancer was 72.5% (58/ 80). The positive expression rate of survivin in breast cancer tissues was 2.7. 5% (22/ 80), and the difference was statistically significant (P0.05). The expression level of EGFR in breast cancer was related to tumor size, histological grade, clinical stage and lymph node metastasis (P0.05). The expression level of Survivin in breast cancer was correlated with lymph node metastasis (P0.05). The expression of these two tumor markers was not related to the age of the patient (P0.05). In all patients, in the low expression group of EGFR, the total effective rate (p-CR, c-CR and PR) of the high-expression group reached the p-CR, c-CR and PR, and the clinical total effective rate (p-CR, c-CR and PR) of the low-expression group of the EGFR was significantly higher than that of the EGFR-high-expression group (95. 08% VS 47. 37% P = 0.000), and 49 cases of the survivin low-expression group reached the p-CR, The total effective rate (p-CR, c-CR, and PR) of the high-expression group (p-CR, c-CR and PR) of the high-expression group was significantly higher than that of the high-expression group (80.96% VS 60. 87% P = 0.013). Conclusion 1. The level of expression of EGFR and survivin in breast cancer is higher than that of the normal breast (P0.05). The expression level of EGFR in breast cancer was related to tumor size, histological grade, clinical stage and lymph node metastasis (P0.05). The expression level of survivin in breast cancer was correlated with lymph node metastasis (P0.05). The expression of EGFR and survivin may be an effective predictor of neoadjuvant chemotherapy in breast cancer.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9
本文編號：2399506
[Abstract]:Background and target breast cancer is one of the most common malignant tumors in the world, and has reached the first[1] of the incidence of female malignant tumor, and the newly diagnosed breast cancer accounts for a considerable proportion of the female malignant tumor every year in an increase of one year. About 600,000 people have died, and the incidence of breast cancer in the western developed countries is high[2]. In recent years, with the lifestyle of high-protein, high-calorie and high-fat life, the incidence of breast cancer has been close to the world level in our country, especially in the developed region of the east, seriously endangering the health of the general female[3]. Although the rate of morbidity is maintained at a high level, the mortality rate has not increased, but rather a decline, which has benefited from the ongoing improvement in the diagnosis and treatment of breast cancer, with the greatest achievement being the implementation of the new adjuvant chemotherapy[4]. The neoadjuvant chemotherapy is a method of chemotherapy for systemic treatment of the cytotoxic drug prior to the radical mastectomy and/ or local radiotherapy of the breast cancer in the absence of metastasis in the malignant tumor. The new adjuvant chemotherapy eliminates many of the disadvantages of the adjuvant chemotherapy, can reduce the volume of the primary mass, and lead the clinical stage of the breast cancer patient to be reduced, so that the lesion which cannot be operated or cannot be completely cut can be radically cured, and the feasibility of the chemotherapy scheme can be detected[6]. Due to the large number of new adjuvant chemotherapy regimens, it is necessary to select different targeted solutions in combination with the patient's actual situation when selecting a chemotherapy regimen[7]. Therefore, the prediction factor of the new adjuvant chemotherapy has come into being, and it may be the focus of the people's research. EGFR is the most common epidermal growth factor receptor in humans, and survivin is a newly discovered member of the apoptosis-inhibiting protein family in recent years[9]. In this study, 80 cases of breast cancer and the normal breast specimens were collected in the breast surgery of the Affiliated Hospital of Zheng's First Affiliated Hospital. The expressions of EGFR and survivin were used to study the predictive ability of EGFR and survivin in the treatment of neoadjuvant chemotherapy[10]. Methods 80 cases of breast cancer and other normal breast specimens from August 2015 to August 2016 were collected from August 2015 to August 2016 according to the standard and exclusion criteria of the group. The relationship between these factors and the patient's age, tumor volume, tissue level, clinical stage and lymph node metastasis was analyzed, and the relationship between these factors and the prognosis of breast cancer was analyzed. Results 1. The positive expression rate of EGFR in breast cancer tissues was 68. 8% (55/ 80). The positive rate of survivin in the normal breast tissue was 32.8% (27/ 80). The positive rate of survivin in breast cancer was 72.5% (58/ 80). The positive expression rate of survivin in breast cancer tissues was 2.7. 5% (22/ 80), and the difference was statistically significant (P0.05). The expression level of EGFR in breast cancer was related to tumor size, histological grade, clinical stage and lymph node metastasis (P0.05). The expression level of Survivin in breast cancer was correlated with lymph node metastasis (P0.05). The expression of these two tumor markers was not related to the age of the patient (P0.05). In all patients, in the low expression group of EGFR, the total effective rate (p-CR, c-CR and PR) of the high-expression group reached the p-CR, c-CR and PR, and the clinical total effective rate (p-CR, c-CR and PR) of the low-expression group of the EGFR was significantly higher than that of the EGFR-high-expression group (95. 08% VS 47. 37% P = 0.000), and 49 cases of the survivin low-expression group reached the p-CR, The total effective rate (p-CR, c-CR, and PR) of the high-expression group (p-CR, c-CR and PR) of the high-expression group was significantly higher than that of the high-expression group (80.96% VS 60. 87% P = 0.013). Conclusion 1. The level of expression of EGFR and survivin in breast cancer is higher than that of the normal breast (P0.05). The expression level of EGFR in breast cancer was related to tumor size, histological grade, clinical stage and lymph node metastasis (P0.05). The expression level of survivin in breast cancer was correlated with lymph node metastasis (P0.05). The expression of EGFR and survivin may be an effective predictor of neoadjuvant chemotherapy in breast cancer.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9
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