乳腺癌剪切波弹性模量最大值Emax与其免疫组化相关性研究

发布时间：2018-04-24 01:16

本文选题：乳腺癌 + 剪切波弹性成像　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:应用实时剪切波弹性成像(Shear-wave elastography,SWE)技术分析乳腺癌肿块弹性模量最大值Emax与肿块大小、组织分级、免疫组化指标雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(C-erbB-2)、Ki-67表达情况及分子分型之间的关系,寻求一个可以评价乳腺癌生物学行为的新指标,为乳腺癌治疗策略的选择及预后判断提供一定的参考依据。方法:选择经病理证实的乳腺癌患者160例(乳腺癌病灶171个),年龄28-75岁,平均(53.8±19.3)岁。术前均行常规超声及SWE检查,SWE模式下测量弹性模量最大值Emax,同一病灶重复测量3次,取平均值;二维声像图下分别测量肿块的左右径、上下径、前后径,取其中最大的径线,将其分为10mm、10-20mm、20mm三组;术后根据病理结果记录肿块的组织分级、免疫组化ER、PR、C-erbB-2、Ki-67表达情况及分子分型情况。比较不同大小、不同组织分级肿块的Emax值的差异;比较免疫组化ER、PR、C-erbB-2、Ki-67表达阳性与阴性者的Emax值的差异;比较不同分子分型间的Emax值的差异;将差异显著的变量纳入多元线性回归分析,由偏回归系数确定各指标贡献程度,评估对Emax值影响最大的因素。结果:1.肿块大小与肿块弹性模量最大值Emax呈显著正相关,肿块体积大者Emax值大于体积小者(rs=0.510,P0.05),Emax值较大者拥有较大的肿块大小。2.C-erbB-2、Ki-67阳性表达者与阴性表达者Emax值存在显著差异,C-erbB-2、Ki-67阳性表达者肿块Emax值大于阴性表达者(t=-3.269、-2.079,P均0.05)。3.不同分子亚型的肿块间弹性模量最大值Emax值差异显著(P0.05),其中HER-2阳性型肿块的Emax值最大,其次顺序为Luminal B型、TN型、Luminal A型。分别将不同分子亚型肿块的Emax值两两比较,Luminal B型与TN型差异无统计学意义(P0.05),余各型肿块Emax值两两比较差异均具有统计学意义(P0.05)。4.多元回归方程的调整后绝对系数Adjust R2=0.306(F=38.446,P0.05),肿块大小和C-erbB-2表达情况可以解释Emax值变异的30.6%,二者偏回归系数分别为:0.500、0.237(P均0.05),肿瘤大小、C-erbB-2对肿物硬度影响最大。结论:1.乳腺癌肿块大小和C-erbB-2、Ki-67表达情况对肿块弹性模量最大值Emax有一定的影响,其中肿块大小和C-erbB-2对Emax值的影响程度最大。2.不同分子亚型肿块间Emax值不同,HER-2阳性型肿块Emax值最大,其后依次为luminal B型、TN型、luminal A型,预后差的乳腺癌肿块往往具有较高的Emax值。3.Emax可以在一定程度上反映乳腺癌的生物学特性,SWE可能成为一个新的手段,为乳腺癌的预后判断及治疗方案的选择提供一定的依据。
[Abstract]:Objective: to analyze the maximum modulus of elasticity (Emax), tumor size and tissue grade of breast cancer by using Shear-wave elastography technique. The expression of estrogen receptor ERA, progesterone receptor PRA, human epidermal growth factor receptor 2C-erbB-2 and Ki-67 and their molecular typing were studied in order to find a new index to evaluate the biological behavior of breast cancer. To provide a certain reference for breast cancer treatment strategy selection and prognosis judgment. Methods: a total of 160 patients with breast cancer (171 breast cancer lesions aged 28-75 years, mean 53.8 卤19.3 years) were selected. The maximum modulus of elasticity (Emaxmax) was measured by conventional ultrasound and SWE before operation, the same lesion was measured 3 times, the mean value was taken, and the diameter of left and right, upper and lower diameters, anteroposterior diameters of the masses were measured under two-dimensional sonogram, and the largest diameter was taken. They were divided into three groups: 10 mm 10 ~ 20 mm ~ 20 mm, the histological grade of the tumor was recorded according to the pathological results, the expression of C-erbB-2 Ki-67 and the molecular type of the tumor were observed by immunohistochemistry. The difference of Emax value in different tissue grade tumor, the difference of Emax value between positive and negative expression of C-erbB-2Ki-67 in ERT were compared, and the difference of Emax value among different molecular types was also compared. The variable with significant difference was incorporated into the multivariate linear regression analysis, and the contribution degree of each index was determined by partial regression coefficient, and the factors that had the greatest influence on Emax value were evaluated. The result is 1: 1. There was a significant positive correlation between the tumor size and the maximum modulus of elasticity (Emax). There was significant difference in Emax value between the positive expression of C-erbB-2Ki-67 and the negative expression in the Emax value of the large tumor than that in the small one (P < 0.05). There was significant difference between the positive expression of C-erbB-2Ki-67 and the Emax value of the negative expression. The Emax value of the tumor with the positive expression of C-erbB-2Ki-67 was higher than that of the negative expression (P < 0.05). There was significant difference in the maximum Emax value of elastic modulus among the different molecular subtypes. The Emax value of HER-2 positive tumor was the largest, followed by Luminal B type TN and Luminal A type. There was no significant difference in Emax value between luminal B type and TN type, but there was significant difference in Emax value of other types of tumor. The absolute coefficient of the multivariate regression equation, Adjust R2O 0.306FU 38.446, P0.05A, the tumor size and the expression of C-erbB-2 can explain the variation of Emax value. The partial regression coefficients of the two regression equations are respectively 0. 05 and 0. 05%, and the size of tumor C-erbB-2 has the greatest effect on the hardness of the tumor. Conclusion 1. The tumor size and the expression of C-erbB-2Ki-67 in breast cancer had a certain influence on the maximum modulus of elasticity (Emax), in which the tumor size and C-erbB-2 had the greatest influence on the Emax value. The Emax value of HER-2 positive tumors was the highest among different molecular subtypes, followed by luminal B type TN and luminal A type. Breast cancer masses with poor prognosis often have higher Emax value. 3. Emax can reflect the biological characteristics of breast cancer to some extent. It may become a new method for judging the prognosis of breast cancer and the choice of treatment plan.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R445.1

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