EGFR和survivin对乳腺癌新辅助化疗疗效的预测价值
发布时间：2019-01-03 14:30
【摘要】：背景与目的乳腺癌是临床上女性最常见到的恶性肿瘤之一,目前已达到女性恶性肿瘤发病率的第一位[1],并且在一年一年的增加,每年新确诊的乳腺癌患者在女性恶性肿瘤中占相当大的比例,约60万人发生死亡事件,西方发达国家女性乳腺癌发病率高[2]。近年来,随着生活方式逐渐向高蛋白、高热量、高脂肪的生活方式转化,在我国特别是东部发达地区,乳腺癌的发病率已接近世界水平,严重危害了广大女性的健康[3]。虽然发病率维持在很高的水平,死亡率却没有增加,反而表现为下降,这获益于乳腺癌诊断和医治方式的一直提高,最大的成就就是新辅助化疗的实施[4]。新辅助化疗就是在恶性肿瘤还没有发生转移的时候,赶在行乳腺癌根治术和/或局部放疗之前,先给予细胞毒性药物给予全身治疗的化疗方法[5]。新辅助化疗排除了辅助化疗的许多劣势,可以降低原发肿块的体积,使乳腺癌患者的临床分期下降,使不能手术切除或者不能完全切除的病灶得到根治,并可检测化疗方案的可行性[6]。由于新辅助化疗方案众多,在选择化疗方案的时候,需要结合患者实际情况选择不同有针对性的方案[7]。因此,新辅助化疗疗效的预测因子应运而生,以后可能会一直成为人们研究的重点[8]。EGFR是人类最常见的表皮生长因子受体,survivin是近些年新发现的凋亡抑制蛋白家族成员[9]。本课题搜集郑大一附属医院乳腺外科诊疗的乳腺癌及其癌旁正常乳腺标本各80例,这些患者都做过EGFR和survivin的免疫组化,探究EGFR和survivin对新辅助化疗疗效的预示能力[10]。方法按照入组标准及排除标准,搜集2015年8月至2016年8月经我科诊疗的乳腺癌及其癌旁正常乳腺标本各80例,这些患者都做过EGFR和survivin的免疫组化,运用与统计学统计标本中EGFR、survivin的状况,并剖析这些因子与患者年龄、肿瘤体积、组织水平分级、临床分期及淋巴结有无转移之间的关系,以及分析其与乳腺癌预后之间的关系。结果1.EGFR在乳腺癌组织中的的阳性表达率为68.8%(55/80),显著高于癌旁正常乳腺组织中的阳性率33.8%(27/80),差异具有统计学意义(P0.05)。survivin在乳腺癌组织的阳性率为72.5%(58/80),高于癌旁组织的阳性表达率27.5%(22/80),差异具有统计学意义(P0.05)。2.乳腺癌组织中EGFR的表达水平与肿瘤大小、组织学分级、临床分期、淋巴结转移相关(P0.05),乳腺癌中Survivin表达水平与淋巴结转移相关(P0.05),与肿瘤体积大小、组织学分级水平、临床分期没有关系(P0.05),这两种肿瘤生物学标志物表达与患者年龄没有关系(P0.05)。3.所有患者,在EGFR低表达组,58例患者达到p CR、c CR和PR,高表达组9例达到p CR、c CR和PR,EGFR低表达组的临床总有效率(p CR、c CR和PR)明显高于EGFR高表达组(95.08%VS 47.37%P=0.000);49例survivin低表达组达到p CR、c CR和PR,survivin高表达组14例达到p CR、c CR和PR,survivin低表达组的临床总有效率(p CR、c CR和PR)明显高于高表达组(85.96%VS 60.87%P=0.013)。结论1.EGFR和survivin在乳腺癌组织中表达的水平高于癌旁正常乳腺组织(P0.05)。2.乳腺癌组织中EGFR的表达水平与肿瘤大小、组织学分级、临床分期、淋巴结转移相关(P0.05),乳腺癌中survivin表达水平与淋巴结转移相关(P0.05),与肿瘤大小、组织学分级、临床分期无关(P0.05),二者均与年龄无关(P0.05)。3.EGFR和survivin的表达程度高低可能是乳腺癌新辅助化疗疗效的一个有效预测指标。
[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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
本文编号：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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
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