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乳腺恶性叶状肿瘤被认为源自小叶内或导管周围间质的恶性改变,发生率明显低于乳腺癌,但其是乳腺恶性间叶性肿瘤中最常见的肿瘤。目前,乳腺恶性叶状肿瘤发病具体病因还不明确。有资料[1-2]显示,乳腺恶性叶状肿瘤的发病不仅与种族、年龄和地域等因素有关外,可能还与生育哺乳、内分泌变化及多基因变异等有关。Piwil2蛋白正常表达仅见于胚胎干细胞和生殖干细胞,其他组织均未见表达;但也见于各种肿瘤组织和肿瘤细胞系,其过表达已被认为是肿瘤干细胞的分子标志[3],且与肿瘤的发生、发展紧密相关。已有研究[4]发现,Piwil2蛋白的表达在乳腺癌组织中有高的灵敏度及特异性。目前有关Piwil2蛋白与乳腺恶性叶状肿瘤之间的研究鲜见报道,鉴于此,本实验研究主要探讨Piwil2蛋白在乳腺恶性叶状肿瘤组织中的表达及其与临床病理因素之间的关系,并分析其表达对病人10年生存预后的影响。
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免疫组织化学染色结果显示,Piwil2蛋白着色于细胞膜和细胞质。Piwil2蛋白在50例乳腺恶性叶状肿瘤组织中43例阳性表达,阳性率86.00%;Piwil2蛋白在70例乳腺正常组织中阳性表达0例,阳性率0.00%。2组之间表达差异有统计学意义(χ2=93.82,P < 0.01)(见图 1、2)。
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结果显示,肿瘤直径≥10 cm、Ki-67≥25%、瘤细胞异型性、CyclinD1蛋白阳性表达及核分裂≥15个/10HPF病人Piwil2蛋白的表达升高,差异均有统计学意义(P < 0.05~P < 0.01),而病人不同年龄及术后是否复发Piwil2蛋白的表达差异无统计学意义(P>0.05)(见表 1)。
因素 n Piwil2蛋白 χ2 P 阳性数 阳性率 年龄/岁 ≥56 26 23 88.46 0.01 >0.05 < 56 24 20 83.33 肿瘤直径/cm ≥10 29 28 96.55 4.46 < 0.05 < 10 21 15 71.43 CyclinD1蛋白 阳性 36 34 94.44 5.32 < 0.05 阴性 14 9 64.29 Ki-67 ≥25% 40 37 92.50 4.58 < 0.05 < 25% 10 6 60.00 细胞异型性 显著 38 36 94.74 7.24 < 0.01 不显著 12 7 58.33 术后复发 是 10 10 100.00 0.84 >0.05 否 40 33 82.50 核分裂(/10个高倍镜) ≥15 29 28 96.55 4.47 < 0.05 < 15 21 15 71.43 表 1 Piwil2蛋白的表达与乳腺恶性叶状肿瘤临床病理因素的相关分析
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随访乳腺恶性叶状肿瘤病人10年,43例Piwil2蛋白阳性表达病人,存活28例,生存率为65.12%;7例Piwil2蛋白阴性表达病人,存活7例,生存率为100.0%;Piwil2蛋白阴性表达病人10年生存率高于Piwil2蛋白阳性表达病人,差异有统计学意义(χ2=3.95,P < 0.05)(见图 3)。
Piwil2蛋白在乳腺恶性叶状肿瘤组织中的表达及临床预后分析
Study on the expression of Piwil2 protein in malignant phyllodes tumor tissue and its clinical prognosis
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摘要:
目的 探讨Piwil2蛋白在乳腺恶性叶状肿瘤组织中的表达,分析Piwil2蛋白的表达与乳腺恶性叶状肿瘤相关临床病理因素之间的关系及对病人10年生存预后的影响。 方法 收集乳腺恶性叶状肿瘤女性病人资料50例,同时选取因乳腺炎切除的乳腺正常组织70例作为对照组。采用免疫组织化学法分别检测Piwil2蛋白在乳腺恶性叶状肿瘤、正常乳腺组织中的表达。 结果 Piwil2蛋白在乳腺恶性叶状肿瘤组织中的阳性表达率为86.00%,明显高于正常乳腺组织的0.00%,差异有统计学意义(χ2=93.82,P < 0.01)。Piwil2蛋白的阳性表达率与病人肿瘤直径≥10 cm、Ki-67≥25%、瘤细胞异型性、CyclinD1蛋白阳性表达及核分裂≥15个/10HPF有关(P < 0.05~P < 0.01),而与病人年龄及术后是否复发无关(P>0.05)。乳腺恶性叶状肿瘤Piwil2蛋白阳性表达的病人10年生存率(65.12%)低于Piwil2蛋白阴性表达病人(100.00%),差异有统计学意义(χ2=3.95,P < 0.05)。 结论 Piwil2蛋白的异常表达参与了乳腺恶性叶状肿瘤的演变、发展,也可作为临床预测病人生存预后的参考指标。 Abstract:Objective To investigate the expression levels of Piwil2 protein in breast malignant lobar tumor tissues, and analyze the relationship between Piwil2 protein expression and clinicopathological factors related to breast malignant lobar tumor and its influence on 10-year survival and prognosis of patients. Methods The clinical data of 50 female patients with malignant lobular tumor of breast were collected, and 70 cases of normal breast tissue resected due to mastitis were selected as the control group. The expression levels of Piwil2 protein in malignant lobar tumor and normal breast tissues were detected by EnVisionTM immunohistochemistry. Results The positive expression rate of Piwil2 protein in malignant lobar tumor tissue was 86.00%, which was significantly higher than that in normal breast tissue(0.00%)(χ2=93.82, P < 0.01). The positive expression of Piwil2 protein in malignant lobar tumor tissue was related to the tumor diameter≥10 cm, Ki-67≥25%, oncocyte atypia, CyclinD1 protein positive expression and Karyokinesis≥15/10HPF(P < 0.05 to P < 0.01), but not related to the age and postoperative recurrence(P>0.05). The ten-year survival rate of malignant lobar tumor patients with positive expression of Piwil2 protein(65.12%) was lower than that of patients with negative expression of Piwil2 protein(100.00%), and the difference of which was statistically significant(χ2=3.95, P < 0.05). Conclusions The abnormal expression of Piwil2 protein is involved in the evolution and development of malignant breast lobar tumor, and can also be used as a reference index for predicting the survival and prognosis of patients. -
表 1 Piwil2蛋白的表达与乳腺恶性叶状肿瘤临床病理因素的相关分析
因素 n Piwil2蛋白 χ2 P 阳性数 阳性率 年龄/岁 ≥56 26 23 88.46 0.01 >0.05 < 56 24 20 83.33 肿瘤直径/cm ≥10 29 28 96.55 4.46 < 0.05 < 10 21 15 71.43 CyclinD1蛋白 阳性 36 34 94.44 5.32 < 0.05 阴性 14 9 64.29 Ki-67 ≥25% 40 37 92.50 4.58 < 0.05 < 25% 10 6 60.00 细胞异型性 显著 38 36 94.74 7.24 < 0.01 不显著 12 7 58.33 术后复发 是 10 10 100.00 0.84 >0.05 否 40 33 82.50 核分裂(/10个高倍镜) ≥15 29 28 96.55 4.47 < 0.05 < 15 21 15 71.43 -
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