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目的:探讨磷酸化Akt(pAkt)和P-糖蛋白(P-glycoprotein,P-gp)蛋白表达与乳腺癌新辅助化疗(new adjuvant chemotherapy,NAC)疗效的相关性。方法:选取2008-10-2012-06收治的实施NAC后手术治疗的58例TNM分期为Ⅱ/Ⅲ期女性乳腺癌患者,采用免疫组化检测NAC前空芯针穿刺乳腺肿瘤组织中pAkt和P-gp蛋白的表达情况,采用TUNEL法检测术后石蜡包埋组织肿瘤细胞凋亡指数(apoptosis index,AI),结合NAC疗效进行相关性分析。结果:NAC治疗后客观缓解率为77.6%(45/58);AI与NAC疗效呈正相关关系,r=0.330,P=0.010;pAkt高表达率和P-gp阳性率分别为48.3%(28/58)和37.9%(22/58),pAkt表达高低、P-gp表达与AI之间均呈负相关关系(r=-0.452,P=0.001;r=-0.623,P<0.001),pAkt高表达疗效明显差于pAkt低表达者(χ2=0.708,P=0.008),P-gp阳性表达患者疗效同样明显差于P-gp阴性表达者,χ2=18.17,P<0.001。结论:pAkt高表达和P-gp阳性表达是影响乳腺癌NAC疗效的危险因素。
Objective: To investigate the relationship between the expression of phosphorylated Akt (pAkt) and P-glycoprotein (P-gp) and the efficacy of new adjuvant chemotherapy (NAC) in breast cancer. Methods: Fifty-eight female patients with stage Ⅱ / Ⅲ TNM who were treated with NAC after operation from October 2008 to June 2012 were enrolled in this study. Immunohistochemistry was used to detect the expression of pAkt and P The expression of -gp protein was detected by TUNEL method. The apoptosis index (AI) of the paraffin-embedded tissue was detected by TUNEL, and the correlation between the therapeutic effect and NAC was analyzed. Results: The objective response rate after NAC treatment was 77.6% (45/58). There was a positive correlation between AI and NAC efficacy (r = 0.330, P = 0.010). The positive rates of pAkt and P-gp were 48.3% The expression of pAkt was negatively correlated with the AI (r = -0.452, P = 0.001; r = -0.623, P <0.001) The curative effect of P-gp positive expression was significantly lower than that of negative P-gp expression (χ2 = 0.708, P = 0.008). Conclusion: The high expression of pAkt and the positive expression of P-gp are the risk factors for the efficacy of NAC in breast cancer.