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目的浸润性小叶癌(invasive lobular carcinoma,ILC)组织中Ki-67表达的研究较少,对其预后预测价值尚需进一步文献支持。本研究探讨ILC组织不同临床病理特征下Ki-67表达差异及其与预后的关系。方法收集天津医科大学肿瘤医院2003-01-10-2012-12-15收治的381例乳腺ILC患者的临床病理资料,分析Ki-67与其临床病理特征的相关性。分析不同年龄、月经状态、体质量指数、家族史、肿瘤大小、淋巴结状态、病理学分期、组织学分型、ER状态、PR状态、HER-2状态和p53状态下,Ki-67表达与预后的关系。结果 381例ILC组织中Ki-67低表达76例(19.9%),中表达91例(23.9%),高表达214例(56.2%)。在不同肿物大小(χ~2=12.524,P=0.014)、腋窝淋巴结情况(χ~2=6.114,P=0.047)、临床分期(χ~2=10.434,P=0.034)、ER表达(χ~2=6.339,P=0.041)和组织学类型(χ~2=78.288,P<0.001)情况下,Ki-67表达差异有统计学意义。Ki-67表达与肿物大小(r=0.168,P=0.001)、腋窝淋巴结情况(r=0.108,P=0.036)、临床分期(r=0.149,P=0.004)和组织学类型(r=0.532,P<0.001)呈正相关。Ki-67表达与ER表达呈负相关,r=-0.112,P=0.029。在肿瘤大小2~5cm、有腋窝淋巴结转移及临床Ⅱ期ILC组织中,Ki-67表达对患者总生存(overall survival,OS)差异有统计学意义,P<0.05;而对无病生存(disease-free survival,DFS)差异无统计学意义,P>0.05。Cox多因素分析显示,有无淋巴结转移(P=0.000)是ILC总生存的独立预后因素,而肿瘤大小、临床分期和Ki-67表达水平不是影响ILC总生存的独立预后因素,P>0.05。结论乳腺ILC组织中Ki-67高表达。就诊时肿物越大、有腋窝淋巴结转移和临床分期越高,Ki-67表达水平越高,而ER表达水平越高,Ki-67表达水平越低,肿物大小2~5cm、有腋窝淋巴结转移及临床Ⅱ期,即中低度恶性ILC组织中Ki-67表达对患者预后有一定的预测价值,但不是独立预后因素,Ki-67对ILC预后预测作用尚需进一步研究。
Objective To investigate the expression of Ki-67 in invasive lobular carcinoma (ILC) tissues and to study the prognostic value of Ki-67 in further study. This study was to investigate the difference of Ki-67 expression in ILC tissue with different clinicopathological features and its relationship with prognosis. Methods Clinicopathological data of 381 cases of breast ILC treated at Tumor Hospital of Tianjin Medical University from January 2003 to October 2012 were analyzed. The correlation between Ki-67 and clinicopathological features was analyzed. The relationship between Ki-67 expression and prognosis was analyzed under different age, menstrual status, body mass index, family history, tumor size, lymph node status, pathological staging, histological type, ER status, PR status, HER-2 status and p53 status relationship. Results The expression of Ki-67 was low in 76 cases (19.9%) of 381 ILC tissues, including 91 (23.9%) of them and 214 (56.2%) of them. The expression of ER (χ2 = 10.434, P = 0.034) was significantly different in different tumor sizes (χ ~ 2 = 12.524, P = 0.014), axillary lymph nodes (χ ~ 2 = 6.114, There was significant difference in Ki-67 expression between the two groups (~ 2 = 6.339, P = 0.041) and histological type (χ ~ 2 = 78.288, P <0.001). The expression of Ki-67 was positively correlated with tumor size (r = 0.168, P = 0.001), axillary lymph node status (r = 0.108, P = 0.036), clinical stage (r = 0.149, P = 0.004) and histological type , P <0.001). Ki-67 expression and ER expression was negatively correlated, r = -0.112, P = 0.029. There were significant differences in the overall survival (OS) between patients with tumor size 2 ~ 5cm, axillary lymph node metastasis and clinical stage Ⅱ ILC (P <0.05), but not for disease -free survival, DFS) was no significant difference, P> 0.05. Cox multivariate analysis showed that lymph node metastasis (P = 0.000) was an independent prognostic factor for overall survival of ILC. Tumor size, clinical stage and Ki-67 expression were not independent predictors of overall survival of ILC (P> 0.05). Conclusion The expression of Ki-67 in breast ILC tissue is high. At the time of treatment, the larger the tumor was, the higher the axillary lymph node metastasis and clinical stage were. The higher the expression of Ki-67, the higher the expression of ER. The lower the expression of Ki-67 was, the size of the tumor was 2-5 cm, with axillary lymph nodes Ki-67 expression in metastatic and clinical stage II, low and intermediate grade ILC tissues may have prognostic value in prognosis, but it is not an independent prognostic factor. The prognostic value of Ki-67 in ILC needs to be further studied.