经他莫昔芬治疗的乳腺癌ER、PR阳性率和染色强度与预后的关系  

Prognostic significance of positive rate and staining intensity of ER and PR in tamoxifen-treated patients with invasive breast carcinoma

作　　者：代莹[1] 傅静[2] 魏兵[1] 何度[1] 张红英[1] 步宏[1] 

机构地区：[1]四川大学华西医院病理科,成都610041 [2]四川省人民医院病理科,成都610072

出　　处：《临床与实验病理学杂志》2013年第4期419-423,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(81172536)

摘　　要：目的分析经他莫昔芬治疗的乳腺癌ER和PR的阳性率和染色强度与患者预后的关系及免疫组化检测结果的重复性,探讨ER和PR检测后理想的报告方法。方法采用全自动免疫组化BenchMark XT染色系统检测223例经他莫昔芬治疗的乳腺癌组织中ER和PR的表达,分析阳性率和染色强度与患者预后的相关性;对其中30例进行ER重复染色和3位医师重复判读的对比分析。结果 (1)Kaplan-Meier法描绘生存曲线分析显示,ER高阳性率组(67%～100%)、中阳性率组(34%～66%)患者的无瘤生存率和总体生存率明显好于低阳性率组(1%～33%)(P=0.007,P=0.003);PR高阳性率组(67%～100%)、中阳性率组(34%～66%)患者的无瘤生存率和总体生存率明显好于低阳性率组(1%～33%)(P=0.004,P=0.005)。(2)Kappa分析显示,3位医师间ER阳性率重复性较好(0.727、0.733、0.710),肿瘤细胞染色强度重复性一般(0.593、0.620、0.610)。结论乳腺癌组织中ER、PR阳性率与内分泌治疗疗效和预后关系密切,且阳性率也有较好的重复性。病理诊断报告除应阐明乳腺癌细胞ER、PR阳性/阴性的定性结果外,纳入阳性率信息是必要的,肿瘤细胞染色强度是否需要纳入值得进一步研究。Purpose To determine the prognostic significance of positive rate and staining intensity of estrogen and progesterone recep- tors in tamoxifen-treated patients with invasive breast carcinoma and the repeatability of IHC staining of estrogen receptors and to ex- plore the reasonable reporting elements for ER and PR analysis. Methods 223 tamoxifen-treated patients with invasive carcinoma were included. IHC staining of ER and PR was performed, using BenchMark XT automated immunostainer instrument. Correlation of prognosis with positive rate and staining intensity of ER and PR were analyzed respectively. Repeated ER staining was performed in 30 cases and scored by 3 pathologists blindly. Their scoring results were compared to explore repeatability. Results Kaplan-Meier surviv- al analysis showed that higher disease-free survival （DFS） and overall survival （OS） were demonstrated by patients in higher ER or PR expression group （67%-100% , 34% -66% ）. Kappa analysis indicated that the repeatability was better regarding to positive rate （0. 727, 0. 733, 0. 710） , but not to stainning intensity （0. 593, 0. 620, 0. 610）. Conclusions Positive rates of ER and PR are of great significance for the prognosis of tamoxifen-treated patients with invasive breast carcinoma. Good interpretation repeatability has been observed in the positive rate rather than staining intensity. The proportion of positive cells should be recorded and reported in the pathological reports. Significance of staining intensity is worthy of further investigation.

关 键 词：乳腺肿瘤 ER PR 阳性率 染色强度 重复性 

分 类 号：R737.9[医药卫生—肿瘤]