目的：探讨腋淋巴结阴性乳腺癌组织中 p21waf1、 c erbB 2和 p53基因蛋白表达及其与临床病理参数和预后的关系。方法：应用免疫组化 LSAB方法检测 121例腋淋巴结阴性乳腺癌石蜡切片中 p21waf1、 c erbB 2和 p53蛋白的表达情况；同时应用 Kaplan Meier法及多变量 Cox比例风险模型，分析 3种蛋白表达与预后的关系。结果：（ 1） p21waf1蛋白表达率为 48.8％，与病理组织学分级、 ER状态有关； p53蛋白表达率为 36.4％， c erbB 2蛋白表达率为 26.4％，与组织学分级有关；（ 2） p21waf1阳性表达与 p53表达呈负相关（ P< 0.05）；（ 3） p21waf1阳性组患者无瘤生存率高于阴性组（ P< 0.05）； c erbB 2阳性组患者无瘤生存率明显低于阴性组（ P< 0.01）； Cox模型分析显示仅有 c erbB 2表达对预后有显著影响。结论：乳腺癌组织 p21waf1、 c erbB 2表达与病理组织学分级有相关性； p21waf1表达依赖于 p53途径刺激； p21waf1、 c erbB 2表达与腋淋巴结阴性乳腺癌预后有关，且 c erbB 2表达是一个独立的预后指标。%Objective：The aim of this study was to determine the expression of p21waf1, c erbB 2, and p53 in node negative breast cancer in relation to the clinicopathological parameters and prognosis. Methods： Expression of p21waf1, c erbB 2 and p53 in 121 patients were determined by LSAB immunohistochemical method, and Kaplan Meier method and Cox proportional hazard model were used to analyze the relationship of their expressions with prognosis. Results： (1) The expression rate of p21waf1 was 48.8％ , and was in connection with histological grade and ER positive. (2) The expression rate of p53 and c erbB 2 was 36.4％ and 26.4％ respectively. C erbB 2 positive expression was associated with histological grade. (3) the expression of p21waf1 was inversely correlated with that of p53 protein (P< 0.05). (4) the results of survival analysis with Kaplan Meier method showed that better disease free survival(DFS) in the patients with p21waf1 expression than those without, the negative c erbB 2 expression exhibited a significantly better prognosis than positive c erbB 2 expression (P< 0.01). Conclusions： There was a significant correlation between the expression of p21waf1, c erbB 2,and tumor grade; a p53 indenpent pathway can mainly induce the expression of p21waf1; p21waf1 expression was a good prognostic marker for the patients with node negative breast cancer; c erbB 2 positive expression was an independent prognostic marker.
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