术前淋巴化疗对乳腺癌复发转移的影响及其机制  

Impact of Preoperative Lymphatic Chemotherapy on Relapse and Metastasis of Breast Cancer and Its Mechanism

作　　者：吴武军[1] 曾健[1] 陆云飞[1] 蒋伟哲[2] 陈玲[1] 潘承恩[3] 

机构地区：[1]广西医科大学第一附属医院胃肠腺体外科,广西南宁530021 [2]广西医科大学第一附属医院新药研究中心,广西南宁530021 [3]西安交通大学第一医院普通外科,陕西西安710061

出　　处：《癌症》2005年第12期1537-1541,共5页Chinese Journal of Cancer

基　　金：广西自然科学基金项目(No.0135014)~~

摘　　要：背景与目的:有报道认为淋巴化疗可以增加消化道肿瘤引流区域淋巴结中抗癌药物的浓度,改善预后,关于乳腺癌淋巴化疗的研究尚少见报道。本研究探讨术前淋巴化疗对乳腺癌复发转移的影响及其作用机制。方法:将60例Ⅱ～Ⅲ期乳腺癌患者随机分为两组,淋巴化疗组40例,对照组20例。在改良根治术前72h,淋巴化疗组于肿瘤周围或瘤床注射表阿霉素-活性炭混悬液10mg;对照组注射表阿霉素水溶液10mg,注射部位和方法同淋巴化疗组。用末端转移酶标记法检测腋窝转移淋巴结癌细胞凋亡指数(apoptoticindex,AI);用免疫组化SP法检测Fas/Fas-L蛋白的表达。观察两组患者局部和全身反应,比较复发转移率。结果:淋巴化疗组转移癌细胞AI平均为(9.5±2.7)%,对照组平均(3.8±1.4)%,前者明显高于后者(P﹤0.01);淋巴化疗组Fas蛋白表达比对照组明显上升(P﹤0.05),而Fas-L蛋白表达无明显改变(P﹥0.05)。对照组中有5例患者出现注射部位皮肤红肿发热,两组均无与化疗有关的局部和全身不良反应。淋巴化疗组患者的2年复发转移率为10.34%,低于对照组的38.46%(P﹤0.05)。结论:乳腺癌术前应用活性炭-表阿霉素混悬液淋巴化疗,可能会降低乳腺癌的复发转移率,其作用可能是通过上调Fas蛋白表达、诱导腋窝转移淋巴结癌细胞凋亡实现的。BACKGROUND ＆ OBJECTIVE： Although it is reported that lymphatic chemotherapy could raise drug concentrations in local lymph nodes and prolong survival time of patients with gastrointestinal tumors, its effect on breast cancer has not been explored. This study was to explore the impact of lymphatic chemotherapy on relapse and metastasis of breast cancer, and to investigate the mechanism. METHODS： Sixty patients with breast cancer of stage Ⅱ-Ⅲ were randomized into 2 groups： 40 patients in Epi-CH （carbon activated absorbing epirubicin） group were injected with 10 mg of Epi-CH in the tissue around primary tumor 72 h before modified radical resection; 20 patients in control group were injected with 10 mg of aqueous epirubicin in the same region. The stained nodes full of tumor cells in Epi-CH group and non-stained nodes in control group were selected. The apoptotic index （AI） of cancer cells in metastatic axillary lymph node was calculated by TUNEL method; the expression of Fas/Fas-L proteins was examined by SP immunohistochemistry; the relapse and metastatic rate was compared. RESULTS： The AI of cancer cells in metastatic axillary lymph node was significantly higher in Epi-CH group than in control group E（9.5±2.7）% vs. （3.8±1.4）%, P〈0.01]. The expression of Fas protein was significantly higher in Epi-CH group than in control group （P 〈 0.05）, but the expression of Fas-L protein had no difference between the 2 groups （P〉0.05）. No chemotherapy-related local and whole body reaction occurred in both groups. The relapse and metastatic rate was significantly lower in Epi-CH group than in control group （P〈0.05）. CONCLUSION： Preoperative Epi-CH lymphatic chemotherapy could suppress relapse and metastasis of breast cancer, which might through up-regulating expression of Fas protein and inducing apoptosis of axillary metastasis cells.

关 键 词：乳腺肿瘤 外科手术 淋巴化疗 肿瘤复发 肿瘤转移 凋亡 FAS蛋白 FAS-L蛋白 

分 类 号：R737.9[医药卫生—肿瘤]