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目的研究P-糖蛋白(P-glycoprotein,P-gp)、乳腺癌耐药蛋白(breast cancer drug resistance protein,BCRP)和肺耐药蛋白(pulmonary resistance protein,LRP)在乳腺癌原发灶和腋淋巴结转移灶中表达的差异。方法采用免疫组织化学染色法检测126例乳腺癌患者的原发灶和66例腋淋巴结转移灶中P-gp、BCRP、LRP的表达。结果 (1)P-gp、BCRP及LRP在乳腺癌原发灶中的阳性表达率分别为41.27%(52/126)、38.89%(49/126)、65.87%(83/126),在腋淋巴结转移灶中阳性表达率分别为59.09%(39/66)、63.64%(42/66)、60.61%(40/66)。P-gp、BCRP在乳腺癌淋巴结转移灶中的表达高于原发灶(P<0.05),LRP在原发灶和淋巴结转移灶之间的表达差异无统计学意义。(2)P-gp、BCRP在乳腺癌原发灶和腋淋巴结转移灶中表达差异没有统计学意义(P<0.01),Kappa值分别为0.276、0.356;LRP在原发灶和淋巴结转移灶中的表达差异没有统计学意义(P>0.05)。(3)乳腺癌原发灶中2个耐药蛋白共表达率为35.71%(45/126),3个耐药蛋白同时表达的阳性率为15.08%(19/126),有2个或3个耐药蛋白共表达率为50.79%(64/126),高于单独阳性表达率33.33%(42/126,P<0.05)。腋淋巴结转移灶中2个耐药蛋白共表达率为53.03%(35/66),高于单独阳性表达率(27.27%[18/66],P<0.05);3个耐药蛋白同时表达的阳性率为16.67%(11/66),有2个或3个耐药蛋白共表达率为69.70%(46/66),高于单独阳性表达率(P<0.01)。腋淋巴结转移灶中2个耐药蛋白共表达率及2个或3个耐药蛋白共表达率均高于乳腺癌原发灶中的表达(P<0.05)。(4)Kaplan-Meier生存分析结果表明,乳腺癌腋淋巴结转移灶中P-gp、BCRP及LRP阳性表达者5年总生存期较原发灶耐药蛋白阳性者低(P<0.05)。结论在乳腺癌原发灶和腋淋巴结转移灶中的P-gp、BCRP表达差异有统计学意义,LRP表达则没有明显差异;多个耐药蛋白共表达协同作用为耐药的主要特征,腋淋巴结转移灶中可能具有更强的耐药性。
Objective To investigate the expression of P-glycoprotein (P-gp), breast cancer drug resistance protein (BCRP) and pulmonary resistance protein (LRP) Differences in the expression of lymph node metastases. Methods Immunohistochemical staining was used to detect the expression of P-gp, BCRP and LRP in 126 cases of primary breast cancer and 66 cases of axillary lymph node metastasis. Results (1) The positive rates of P-gp, BCRP and LRP in primary breast cancer were 41.27% (52/126), 38.89% (49/126) and 65.87% (83/126) The positive rates of lymph node metastasis were 59.09% (39/66), 63.64% (42/66) and 60.61% (40/66), respectively. The expression of P-gp and BCRP in breast cancer with lymph node metastasis was higher than that in primary tumor (P <0.05). There was no significant difference in the expression of LRP between primary tumor and lymph node metastasis. (2) The expression of P-gp and BCRP in primary breast cancer and axillary lymph node metastasis had no statistical significance (P <0.01), and the Kappa values were 0.276,0.356 respectively. LRP expression in primary tumor and lymph node metastasis The difference was not statistically significant (P> 0.05). (3) The positive rate of two resistant proteins in primary breast cancer was 35.71% (45/126), the positive rates of three resistant proteins were 15.08% (19/126), two or three The positive rate of drug resistance was 50.79% (64/126), higher than the positive rate of 33.33% (42/126, P <0.05). The positive rate of the two drug-resistant proteins in axillary lymph node metastasis was 53.03% (35/66), which was higher than that of the other two groups (27.27% [18/66], P <0.05) The positive rate was 16.67% (11/66). The co-expression rate of two or three resistant proteins was 69.70% (46/66), which was higher than that of single positive expression (P <0.01). The expression rates of two resistant proteins and two or three resistant proteins in axillary lymph node metastasis were higher than those in primary breast cancer (P <0.05). (4) Kaplan-Meier survival analysis showed that the 5-year overall survival of P-gp, BCRP and LRP positive expression in axillary lymph node metastasis of breast cancer was lower than that of primary resistance protein positive (P <0.05). Conclusion The expression of P-gp and BCRP in primary breast cancer and axillary lymph node metastasis has statistical significance, while there is no significant difference in LRP expression. The multi-resistance protein co-expression is the main characteristic of drug resistance, Lymph node metastases may have more resistance.