摘要
目的分析乳腺癌中ERα、PR的阳性率与预后的关系,探讨影响ERα、PR阳性率的相关因素。方法采用免疫组化En Vision法检测662例乳腺癌组织中ERα、PR的表达,按不同阳性率分组,Kaplan-Meier法分析预后。选择其中的80例采用两种克隆号ERα(SP1、6F11)染色并由一位高年资医师判读,以分析不同克隆号对阳性率的影响;选择其中的214例ERα(SP1)由三位不同年资医师采用Allred score、H score两种判读系统分别判读,以观察不同判读系统及医师经验对阳性率的影响。一致性采用Kappa检验。结果生存分析显示,ERα、PR低阳性组无病生存率(disease-free survival,DFS)、总生存率(overall survival,OS)均优于阴性组(DFS:P=0.021、0.003)、(OS:P=0.019、0.003),ERα、PR高阳性组DFS、OS均优于低阳性组(DFS:P=0.011、0.002)、(OS:P=0.012、0.005)。浸润性癌非特指型、浸润性小叶癌、导管原位癌ERα阳性率分别为59.5%、78.9%、63.6%,差异有统计学意义(P=0.002),PR阳性率分别为56.3%、68.9%、59.1%,差异无统计学意义(P=0.079)。不同组织学分级的浸润性癌非特指型ERα、PR阳性率差异有统计学意义(P均<0.001)。不同核级导管原位癌ERα、PR阳性率差异有统计学意义(P均<0.05)。克隆号SP1阳性细胞百分率、染色强度均优于6F11;判读系统H score重复性略优于Allred score;高年资医师间阳性细胞百分率、染色强度判读重复性好(κ=0.850,κ=0.824),而高年资和低年资医师之间重复性均较差(0.4<κ<0.75);阳性细胞百分率估计法与计数法重复性较差(κ=0.726)。结论 ERα、PR不同阳性细胞百分率与患者预后密切相关,影响ERα、PR阳性率的因素包括病理类型、组织学分级、核分级、抗体的选择、判读系统及判读医师间的差异等。
Purpose To determine the relationship between prognostic significance and positive rate of estrogen receptor α（ERα） and progesterone receptor （PR） in patients with breast cancer, and to explore the influencing factors of ERα and PR expression. Methods 662 specimens of breast cancer were included. Immunohistochemical staining was carried out to detect ERct and PR expression, and the results could be classified into different groups according to the proportion of positive cells. Kaplan-Meier method was used to estimate patients＇ prognosis. 80 cases were immunostained with the two anti-ER antibodies （ SP1 and 6F11 ） and the results were interpreted by one pathologist to investigate clones＇ influence. ERα（ SP1 ） expression of the 214 cases was evaluated by three pathologists with H score and Allred score methods to investigate the influence of interpretation system and experience. The consistency of the results was measured with the Kappa test. Results Survival analysis showed disease-free survival （DFS） and overall survival （OS） were better in both ERα and PR low expression groups than that in negative groups, and in high positive groups DFS and OS were better than that in low expression groups. In invasive carcinoma of no special type （NST） , invasive lobular carcinoma （ILC） and ductal carcinoma in situ （DCIS） groups, positive rates of ERα were 59. 5%, 78.9% and 63.6% respectively （P =0. 002）. PR positive rates were 56. 3%, 68.9% and 59. 1% （ P = 0. 079）. ERα and PR positive rates were associated with different histological grades in NST （P 〈 0. 001 ） and different nuclear grades in DCIS （P 〈 0. 05）. Kappa test indicated that SP1 was a better antibody （with stronger staining intensity and higher positive rate） than 6F11, the repeatability of the H score system was better than that of Allred score system, the repeatabilities of positive rate and staining intensity were better among senior pathologists （ κ = 0. 850,κ = 0. 824）, but not between the senior and junior pathologists （0.4 〈 K 〈 0. 75 ）, the repeatability was not that good regarding to the estimation and count of the positive rates （ κ = 0. 726）. Conclusion The different positive rates of ERα and PR are closely related to patients＇ prognosis, and the positive rates of ERα and PR can be influenced by many variables pathological types, histological grade, nuclear grade, antibody selection, interpretation system and the experience of the pathologists.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2016年第1期13-18,共6页
Chinese Journal of Clinical and Experimental Pathology
