经他莫昔芬治疗的乳腺癌ER、PR阳性率和染色强度与预后的关系

摘要

Purpose To determine the prognostie signifieance of positive rate and staining intensity of estrogen and progesterone receptors in tamoxifen-treated patients with invasive breast carcinoma and the repeatability of IHC staining of estrogen receptors and to explore the reasonable reporting elements for ER and PR analysis.Methods 223 tamoxifen-treated patients with invasive carcinoma were included.IHC staining of ER and PR was performed, using BenchMark XT automated imrnunostainer instrument.Correlation of prognosis with positive rate and staining intensity of ER and PR were analyzed respectively.Repeated ER staining was performed in 30 cases and scored by 3 pathologists blindly.Their scoring results were compared to explore repeatability.Results Kaplan-Meier survival analysis showed that higher disease-free survival ( DFS ) and overall survival ( OS ) were demonstrated by patients in higher ER or PR expression group (67% ~ 100% , 34% ~ 66% ).Kappa analysis indicated that the repeatability was better regarding to positive rate ( 0.727, 0.733 , 0.710 ), but not to stainning intensity ( 0.593 , 0.620, 0.610 ).Conclusions Positive rates of ER and PR are of great significance for the prognosis of tamoxifen-treated patients with invasive breast carcinoma.Good interpretation repeatability has been observed in the positive rate rather than staining intensity.The proportion of positive cells should be recorded and reported in the pathological reports.Significance of staining intensity is worthy of further investigation.%目的 分析经他莫昔芬治疗的乳腺癌ER和PR的阳性率和染色强度与患者预后的关系及免疫组化检测结果 的重复性,探讨ER和PR检测后理想的报告方法.方法 采用全自动免疫组化BenchMark XT染色系统检测223例经他莫昔芬治疗的乳腺癌组织中ER和PR的表达,分析阳性率和染色强度与患者预后的相关性;对其中30例进行ER重复染色和3位医师重复判读的对比分析.结果 (1)Kaplan-Meier法描绘生存曲线分析显示,ER高阳性率组(67%～100%)、中阳性率组(34%～66%)患者的无瘤生存率和总体生存率明显好于低阳性率组(1%～33%)(P=0.007,P=0.003);PR高阳性率组(67%～100%)、中阳性率组(34%～66%)患者的无瘤生存率和总体生存率明显好于低阳性率组(1%～33%)(P=0.004,P=0.005).(2)Kappa分析显示,3位医师间ER阳性率重复性较好(0.727、0.733、0.710),肿瘤细胞染色强度重复性一般(0.593、0.620、0.610).结论 乳腺癌组织中ER、PR阳性率与内分泌治疗疗效和预后关系密切,且阳性率也有较好的重复性.病理诊断报告除应阐明乳腺癌细胞ER、PR阳性/阴性的定性结果 外,纳入阳性率信息是必要的,肿瘤细胞染色强度是否需要纳入值得进一步研究.