乳腺癌及前驱病变肿瘤分子标记物联合动态监测的研究与临床应用  

Research and clinical application of breast cancer and precancerous lesions tumor molecular markers combining dynamic detection

作　　者：王刚平[1] 田玉峰[1] 徐风亮[1] 梁粉花[1] 梁云爱[1] 张红[1] 

机构地区：[1]日照市人民医院病理科,山东日照276826

出　　处：《医学检验与临床》2013年第5期1-4,45,共5页Medical Laboratory Science and Clinics

基　　金：日照市应用技术研究与开发计划项目（2060402-社会发展-4）

摘　　要：目的：探讨乳腺癌及前驱病变肿瘤分子标记物联合动态监测的临床意义。方法：对100例乳腺癌、104例癌前病变（28例导管非典型增生ADH、31例低级别原位癌LG-DCIS、45例高级别原位癌HG-DCIS）患者采用化学发光法检测血清CA15-3、TPS、CA125的水平，化学显色法检测TSGF；ELISA法检测OPN分子标记物水平，并与30例正常乳腺组对照，结合ER、PR、c-erbB-2、Ki-67等临床病理因素统计分析。结果：与癌前病变组、正常乳腺对照组比较，乳腺浸润性导管癌分子标记物差异有统计学意义（P〈0．01）；与LG-DCIS、ADH及正常对照组比较，HG-DCIS血清CAl5-3、TSGF水平差异有统计学意义（P〈0．05）；LG-DCIS与ADH、正常对照组肿瘤标记物血清水平降低，但组间差异无统计学意义（P〉0．05）。血清肿瘤标记物水平与肿瘤大小（1cm为界）、患者年龄（50岁为界）、肿瘤部位、灶数（单灶、多灶）无关（P〉0．05）；与ER、PR、c-erbB-2、Ki-67差异相关，ER、PR阳性程度高，肿瘤标志物低负相关（P〈0．05）；c-erbB-2、Ki-67（20％为界）高则肿瘤标志物高正相关（P〈0．05）；淋巴结转移组与无转移组差异有统计学意义（P〈0．05）。与各单项检测相比，联合检测敏感性、准确性、阴性预测值明显提高，P〈0．05。结论：CA15-3、TPS、CA125、TSGF、OPN是乳腺导管癌诊断和监控转移的较好指标，对乳腺高级别粉刺型原位癌诊断和治疗、随访有-定价值，但对癌前病变诊断无特异性。Objective ： To study the Significance of dynamic detection for the serum tumor marker in breast cancer and Precancerous lesions. Methods ： The serum from 100 patients with breast invasive ductal carcinomas and 104 patients with Precancerous lesions（28 cases of atypical ductal hyperplasia, 31 cases of low-grade ductal carcinoma in situ,45 cases of high-grade ductal carcinoma in situ） was collected and tumor markers CA15-3 and CA125 was detected with electrochemiluminescence method, and TSGF was detected with Chemocolorimetry method, and OPN was detected with Enzyme-linked immunosorbent assay method, and was compared with 30 cases normal breast tissue.Results ： The serum levels of CA15-3,TPS,CA125,TSGF and OPN in bresat cancer patients were significantly higher than those in the Precancerous lesions and normal breast tissue （P〈0.05）, and had a positive correlation with c-erbB-2 and Ki-67,and positive correlation with lymphnode metastas too. The sensitivity of the five tumor markes and X-ray mammography in combination was 96.1% and specificity was 83.3%. Conclusions ~ The dynamic combined detection of CA15-3,TPS,CA125,TSGF and OPN are better prewarning markers for diagnosis of breast cancer ,and benefit to monitoring their recurrence and metastasis of breast cancer, but cannot increase the sensitivity of diagnosis of Precancerous lesions.

关 键 词：乳腺癌 癌前病变 肿瘤分子标记物  血清 诊断  鉴别诊断 

分 类 号：R735.2[医药卫生—肿瘤]