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目的探讨采用CTF方案新辅助化疗后乳腺癌组织中凋亡抑制蛋白survivin的表达及其与肿瘤细胞凋亡、增殖的相互关系和临床意义。方法采用免疫组化SABC法,检测60例行新辅助化疗和60例未行新辅助化疗的乳腺癌组织中survivin和Ki-67的表达,并采用原位细胞末端转移标记法(TUNEL法)测定细胞凋亡指数(AI)。结果新辅助化疗组survivin阳性表达率为36.7%(22/60),明显低于对照组(71.7%,43/60)(χ2=14.821,P<0.001)。新辅助化疗组Ki-67阳性表达率(38.3%,23/60)明显低于对照组(61.7%,37/60,χ2=6.533,P<0.05)。新辅助化疗组AI均数为(9.34±3.12)%,对照组AI均数为(5.27±3.16)%,两组比较差异有统计学意义(γ=1.998,P<0.05)。新辅助化疗组survivin表达与AI呈负相关(γ=-0.36,P<0.05),而与Ki-67表达呈正相关(γ=+0.47,P<0.05)。新辅助化疗组化疗总有效率为73.3%(44/60),化疗后部分缓解(Ⅱ级)病例survivin表达水平(18.2%,8/44)明显低于无效(Ⅲ级)病例(81.3%,13/16)(χ2=20.514,P<0.001)。结论应用CTF方案新辅助化疗,缓解率高,近期疗效明显。Survivin表达水平可作为预测乳腺癌新辅助化疗疗效的指标。
Objective To investigate the expression of survivin protein and its relationship with the apoptosis and proliferation of breast cancer cells after neoadjuvant chemotherapy with CTF regimen. Methods Immunohistochemical SABC method was used to detect the expression of survivin and Ki-67 in 60 patients with neoadjuvant chemotherapy and 60 without neoadjuvant chemotherapy. The expression of survivin and Ki-67 was detected by TUNEL method Apoptosis index (AI). Results The positive expression rate of survivin in neoadjuvant chemotherapy group was 36.7% (22/60), which was significantly lower than that in control group (71.7%, 43/60) (χ2 = 14.821, P <0.001). Ki-67 positive rate in neoadjuvant chemotherapy group (38.3%, 23/60) was significantly lower than that in control group (61.7%, 37/60, χ2 = 6.533, P <0.05). The average number of AI in the neoadjuvant chemotherapy group was (9.34 ± 3.12)%, while that in the control group was (5.27 ± 3.16)%. The difference between the two groups was statistically significant (γ = 1.998, P <0.05). The expression of survivin in neoadjuvant chemotherapy group was negatively correlated with AI (γ = -0.36, P <0.05), but positively correlated with Ki-67 expression (γ = +0.47, P <0.05). The total effective rate of neoadjuvant chemotherapy was 73.3% (44/60). The expression of survivin (18.2%, 8/44) in patients with partial remission (grade Ⅱ) after chemotherapy was significantly lower than that in patients without grade Ⅲ (81.3% 13/16) (χ2 = 20.514, P <0.001). Conclusion CTF regimen neoadjuvant chemotherapy, high response rate, the recent curative effect. Survivin expression level can be used as an index to predict the efficacy of neoadjuvant chemotherapy in breast cancer.