脉管癌栓中间质细胞/癌细胞、巨噬细胞/癌细胞比值与pT 1~4 N 1~3 M 0期乳腺癌患者临床病理特征及预后的关系  

Relationship between the ratio of mesenchymal cells or macrophages to cancer cells in lymphovascular invasion and clinicopathologic features and prognosis of pT 1-4 N 1-3 M 0 breast cancer patients

作　　者：范丽娟 王嘉 高雪[3] 毛晓韵[1] 王旭[1] 郑昂[1] 马楠 金锋[1] Fan Lijuan;Wang Jia;Gao Xue;Mao Xiaoyun;Wang Xu;Zheng Ang;Ma Nan;Jin Feng(Department of Breast Surgery,First Affiliated Hospital of China Medical University,Shenyang 110001,China;Department of Breast Surgery,Second Hospital of Dalian Medical University,Dalian 116000,China;Department of Pathology,First Affiliated Hospital of Dalian Medical University,Dalian 116000,China;Department of Oncology,Northern Theater General Hospital of PLA,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院乳腺外科,沈阳110001 [2]大连医科大学附属第二医院乳腺外科,116000 [3]大连医科大学附属第一医院病理科,116000 [4]北部战区总医院肿瘤科,沈阳110001

出　　处：《中华乳腺病杂志（电子版）》2020年第1期23-31,共9页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：国家自然科学基金资助项目(81773163、81602309)。

摘　　要：目的探讨脉管癌栓中间质细胞/癌细胞比值、巨噬细胞/癌细胞比值与pT 1~4 N 1~3 M 0期乳腺癌患者临床病理特征及预后的关系。方法采用回顾性研究方法,选取2013年1月至2015年12月在中国医科大学附属第一医院及大连医科大学附属第一、二医院经系统治疗并有完整随访资料的167例pT 1~4 N 1~3 M 0期腋窝淋巴结阳性乳腺癌患者作为研究对象,中位随访55.2个月(16.8~69.6个月)。采用免疫组织化学染色方法分别检测脉管癌栓中间质细胞和巨噬细胞的数目,计算间质细胞/癌细胞比值及巨噬细胞/癌细胞比值,采用Ward法分别对间质细胞/癌细胞比值和巨噬细胞/癌细胞比值进行聚类,得到低比值和高比值两类。分别采用Kruskal-Wallis H检验、χ^2检验分析该比值与患者临床病理特征的关系,并用log-rank检验分析该比值与患者预后的关系。结果167例患者间质细胞/癌细胞、巨噬细胞/癌细胞比值的M(P 25~P 75)分别为0.025(0.015~0.063)和0.023(0.015~0.036)。间质细胞/癌细胞比值与患者的组织学分级、肿瘤大小、腋窝淋巴结转移状态、临床分期及脉管浸润有关(χ^2=10.210、6.210、64.315、56.901、19.771,P=0.001、0.045及P均<0.001),但与ER、PR、HER-2、Ki67表达及神经侵犯无关(χ^2=3.148、2.260、3.187、0.145、1.384,P=0.076、0.133、0.074、0.704、0.240);巨噬细胞/癌细胞比值与患者的肿瘤大小、ER表达、神经侵犯、组织学分级、腋窝淋巴结转移状态、临床分期、脉管浸润和HER-2表达有关(χ^2=7.487、6.680、8.439、13.002、25.856、31.394、19.771、27.921,P=0.024、0.010、0.004及P均<0.001),但与PR、Ki67表达无关(χ^2=3.616、1.183,P=0.057、0.277)。聚类后间质细胞/癌细胞比值与腋窝淋巴结转移状态及临床分期均有关系(χ^2=47.300,P<0.001;χ^2=14.260,P=0.001),而巨噬细胞/癌细胞比值仅与ER表达有关(χ^2=5.136,P=0.023)。间质细胞/癌细胞、巨噬细胞/癌细胞比值均与�Objective To investigate the relationship between the ratio of mesenchymal cells to cancer cells or macrophages to cancer cells in lymphovascular invasion(LVI)and clinicopathologic features and prognosis of pT 1-4 N 1-3 M 0 breast cancer patients.Methods A total of 167 pT 1-4 N 1-3 M 0 breast cancer patients who received systemic treatment and had complete follow-up data in the First Affiliated Hospital of China Medical University,the First and Second Affiliated Hospitals of Dalian Medical University from January 2013 to December 2015 were enrolled in this retrospective study,with a median follow-up period of 55.2 months(16.8-69.6 months).Immunohistochemistry was used to identify the number of mesenchymal cells or macrophages in LVI.The ratio of mesenchymal cells to cancer cells and the ratio of macrophages to cancer cells in LVI were calculated.The Ward clustering method was used to divide the patients into two groups:high-ratio group and low-ratio group.Kruskal-Wallis H test andχ^2 test were used to analyze the relationship between the ratios and clinicopathologic features of breast cancer patients;the log-rank test was used to analyze the relationship between the ratios and the patient prognosis.Results The ratios[M(P 25-P 75)]of mesenchymal cells to cancer cells and macrophages to cancer cells in 167 patients were 0.025(0.015-0.063)and 0.023(0.015-0.036),respectively.The ratio of mesenchymal cells to cancer cells was correlated with histological grade,tumor size,lymph node metastasis,clinical stage and LVI(χ^2=10.210,6.210,64.315,56.901,19.771;P=0.001,0.045,and all P<0.001),but not correlated with ER,PR,HER-2,Ki67 expression and nerve invasion(χ^2=3.148,2.260,3.187,0.145,1.384;P=0.076,0.133,0.074,0.704,0.240).The ratio of macrophages to cancer cells was correlated with tumor size,ER expression,nerve invasion,histological grade,lymph node metastasis,clinical stage,LVI and HER-2 expression(χ^2=7.487,6.680,8.439,13.002,25.856,31.394,19.771,27.921;P=0.024,0.010,0.004,all P<0.001),but not correlated with Ki67

关 键 词：间质细胞 巨噬细胞 乳腺肿瘤 存活率 预后 脉管癌栓 肿瘤微环境 

分 类 号：R737.9[医药卫生—肿瘤]