改良EDTA脱钙法和酸脱钙法在乳腺癌骨转移免疫组织化学中的比较研究  

Comparative study of modified EDTA decalcification and acid decalcification in immunohistochemistry of breast cancer with bone metastasis

作　　者：孙静 袁俊清 杨梦迪 王智煜[1] 姚光宇 周亦一 赵晖[1] SUN Jing;YUAN Junqing;YANG Mengdi;WANG Zhiyu;YAO Guangyu;ZHOUYiyi;ZHAO Hui(Department of Medical Oncology,Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai 200233,China;Department of Pathology,Shanghai Jiao Tong University Affiliated Sixth People’sHospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院肿瘤内科,上海200233 [2]上海交通大学附属第六人民医院病理科,上海200233

出　　处：《中国癌症杂志》2019年第7期514-520,共7页China Oncology

基　　金：国家自然科学基金(81672852);上海申康三年行动计划(16CR2007A);上海市教育委员会-高峰临床医学基金(20172024);上海交通大学医工交叉项目(YG2017MS15)

摘　　要：背景与目的:晚期乳腺癌骨转移发生率大于70%,对骨组织进行脱钙处理是一大技术难点。探索乳腺癌骨转移的临床特点及更适合对骨组织进行脱钙的方法。方法:收集2012年1月—2018年1月期间病理学诊断为乳腺癌骨转移患者的临床资料,分析临床特征;分析改良乙二胺四乙酸二钠(ethylenediaminetetraacetic acid,EDTA)脱钙法及酸脱钙法对骨转移组织进行处理后,骨组织形态、结构的差异;比较两组原发灶与转移灶免疫组织化学检查结果中雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)的一致性;分析两组骨转移组织ER、PR、Ki-67的阳性率;分析乳腺癌骨转移患者ER、PR阳性和阴性的生存差异。结果:116例乳腺癌骨转移患者中91.4%为溶骨性骨转移,80.1%骨转移的数量为4~20,81.9%发生骨相关事件(skeletal-related event,SRE)。41例为改良EDTA脱钙,75例为酸脱钙,两组骨组织的形态结构无明显差异。改良EDTA脱钙组ER一致性为95.1%,明显高于酸脱钙组(69.3%)(P<0.05);改良EDTA脱钙组骨组织ER的阳性率为90.2%,明显高于酸脱钙组(73.3%)(P<0.05);改良EDTA组PR的阳性率(58.5%)明显高于酸脱钙组(36.0%)(P<0.05),Ki-67增殖指数明显高于酸脱钙组(P<0.05);骨转移组织ER+患者的平均生存时间为(41.09±4.26)个月,明显优于ER-患者[(25.81±5.71)个月](P<0.05)。结论:乳腺癌骨转移多为多发溶骨性,且SRE发生率高。改良EDTA脱钙法优于酸脱钙法,更适于对骨组织进行脱钙和免疫组织化学制片。Background and purpose:The incidence of bone metastasis in advanced breast cancer(BC)is more than 70%,and decalcification of bone tissue is a technical difficulty.This study aimed to explore the clinical features of BC with bone metastasis and more suitable methods for decalcification of bone tissue.Methods:Clinical data of patients with pathological diagnosis of BC with bone metastases from January 2012 to January 2018 were collected and analyzed for clinical characteristics.We compared the differences in bone morphology and structure between tissues treated with modified ethylenediaminetetraacetic acid(EDTA)decalcification and acid decalcification.We examined the consistency of endocrine receptors between primary and metastatic bone tissues.Then the immunohistochemistry(IHC)results of estrogen receptor(ER),progesterone receptor(PR)and Ki-67 were compared between the two groups. Finally, we analyzed the survival differences of ER and PR status in patients. Results: Among116 patients including 41 cases of modified EDTA decalcification and 75 cases of acid decalcification, 91.4% were osteolytic bonemetastases, 80.1% of bone metastases ranged from 4 to 20, and 81.9% had skeletal-related events (SRE). The consistency of ER inpatients with bone metastases from modified EDTA decalcification group was 95.1%, which was significantly higher than that inacid decalcification group (69.3%) (P<0.05). The positive rates of ER, PR and Ki-67 in the modified EDTA decalcification groupwas significantly higher than those in the acid decalcification group (P<0.05). The mean survival of ER+ patients [(41.09±4.26)months] was significantly longer than that of ER- patients [(25.81±5.71) months](P<0.05). Conclusion: Bone metastases in BCare most likely multiple osteolytic lesions, and the incidence of SRE is high. The modified EDTA decalcification method is superiorto the acid decalcification method and more suitable for decalcification and IHC of bone tissue.

关 键 词：EDTA脱钙 酸脱钙 乳腺癌 骨转移 骨组织穿刺活检 

分 类 号：R737.9[医药卫生—肿瘤]