乳腺癌细胞凋亡及相关基因表达的预后研究  

Prognostic significance of apoptosis and its related genes in human breast cancer

作　　者：吴炅[1] 沈镇宙[1] 邵志敏[1] 

机构地区：[1]上海医科大学肿瘤医院胸外科

出　　处：《上海医学》1999年第1期27-31,共5页Shanghai Medical Journal

摘　　要：目的对细胞凋亡及其相关基因在乳腺癌预后中的作用，以及它们的表达水平与乳腺癌生物学行为的关系进行研究。方法运用ＴＵＮＥＬ法、免疫组化检测乳腺癌组织细胞凋亡水平以及凋亡相关基因ｂｃ１２、ｂａｘ、ｐ２７ｋｉｐｌ表达。结果９１例乳腺癌病例中，５６／９１（６１．５％）的病例凋亡指数较高，３５／９１（３８．５％）凋亡指数较低；ｂｃ１２高表达占２９．７％（２７／９１），ｂａｘ高表达占３０．８％（２８／９１）。１８１例乳腺癌中，ｐ２７ｋｉｐｌ高表达占３３．１％（６０／８１）。相关性分析发现，ｂｃ１２高表达，ＡＩ低的病例，组织学分级高，易出现腋淋巴结转移和术后复发；ｂａｘ、ｐ２７ｋｉｐｌ高表达者，组织学分级低，腋淋巴结转移及术后复发少。单因素生存分析显示，ＡＩ高，ｂａｘ、ｐ２７ｋｉｐｌ高表达，ｂｃ１２低表达的病例，术后无复发生存率、总生存率优于ＡＩ低，ｂａｘ、ｐ２７ｋｉｐｌ低表达，ｂｃ１２高表达者。ＣＯＸ模型多因素分析发现，ｂｃ１２、ｐ２７ｋｉｐｌ蛋白具有独立的预后价值；８４例淋巴结阴性乳腺癌中，ｐ２７ｋｉｐｌ表达有独立预后作用。结论凋亡相关基因ｂｃ１２、ｂａｘ、ｐ２７ｋｉｐｌ表达状态失控，使细胞凋亡过程失调，?Objective The bc1 2 oncogene and bax, p27 kipl contribute to the control of apoptosis. It's not clear if their expression levels are correlated with the biological behavior of breat and their prognostic role in breast cancer patients. Methods In human breast cancer tissue sections, we studied the immunohistochemical expression of bc1 2, bax and p27 kipl proteins, also detected AI(Apoptotic Index) by tunel. Results 91 cases had data about AI, bc1 2 and bax protein. High and low AI were found in 56/ 91(61.5%) and 35/ 91 (38.5%) patients. High bc1 2 and bax expression were found in 29.7%(27/ 91) and 30.8%(28/ 91) patients relatively. High expression of p27 kipl was seen in 60/ 181(33.1%). In breast cancer tissues, high bcl 2 and low AI were associated with high histologic grade, axillary lymph node metastasis and postoperative recurrence. Higher bax, p27 kipl protein expression were reatled to low histologic grade, fewer axillary metastasis and postoperative recurrence. The univariate survival analysis demonstated that patients with high AI, bax, p27 kipl and low bc1 2 showed better relapse free survival(RFS) and overall survial(OS). Bc1 2, p27 kipl proteins were found to have independent prognostic value in COX's model multivariate analysis. In 84 cases of negation axillary lymph node patients, p27 kipl proved to be an independent indicator of patient outcome.Conclusion Our findings indicate that dysrgulated expression of bcl 2, bax and p27 kipl apoptosis related genes are suggestive of serious deregulation of apoptotic process, and may contribute to the biologic aggressiveness of breast cancer. Bcl 2 and p27 kipl are of independent indicators of prognosis in breast cancer patients.

关 键 词：乳腺癌 预后 细胞凋亡 癌基因 

分 类 号：R737.9[医药卫生—肿瘤]