12基因模型对乳腺导管原位癌复发风险预测的回顾性分析

摘要

目的 评估12基因模型对中国人群乳腺导管原位癌(ductal carcinoma in situ,DCIS)的复发预测效能. 方法 对我院2010年1月～2016年1月收治的临床资料齐全的79例DCIS患者的术后石蜡组织标本采用PCR方法进行基因检测,根据12基因模型计算DCIS评分并分组.采用Logistic回归分析DCIS复发相关因素,采用Kaplan-Meier分析不同层次DCIS评分对DCIS复发的影响. 结果 Logistic回归分析显示DCIS病理核分级是其复发的高危因素,高核分级者的复发风险是其他分级者的4.581倍,而其他病理因素(肿块大小,ER、PR及HER2阳性,Ki67阳性表达)以及是否术后行内分泌治疗与DCIS复发并不相关(P＞0.05).对79例患者根据12基因模型计算出的DCIS评分进行分组,低危风险组30例、中危风险组20例、高危风险组29例,随访发现其肿瘤复发/转移者分别为1例(3.3％),2例(10％)和4例(13.8％).Kaplan-Meier分析显示高危风险组在较早出现DCIS复发,而中、低风险组出现复发时间相对较晚,差异有统计学意义(P=0.003). 结论 12基因模型能初步区分中国人群DCIS患者的复发风险等级;利用其进行DCIS预后预测时,结合相关临床病理参数能更好地指导治疗决策.%Objective To evaluate the efficacy of 12-genes DCIS score model predicting the prognosis of ductal carcinoma in situ (DCIS) in Chinese population.Methods A total of 79 DCIS cases with complete clinical data from January 2010 to January 2016 were enrolled into the research.The expression of 12 genes (including Ki67,STK15,Survivin,CCNB1,MYBL2,PR,GSTM1,ACTB,GAPDH,RPLPO,GUS and TFRC) were detected by PCR technique in the 79 postoperative paraffin tissue samples.Then DCIS score were calculated according to the 12-genes model.The correlation factors were analyzed by Logistic regression analysis,and the effect on recurrence/metastasis was studied in different DCIS score groups by Kaplan-Meier test.Results Logistic regression analysis revealed the pathologic nuclear grade was the high risk factors of DCIS recurrence,but other pathologic features (as the size of mass,the ER,PR,HER2 and positive expression of Ki67) was not the related factors of DCIS recurrence.According to DCIS score,79 cases were divided into low risk group (n =30),middle risk group (n =20) and high risk group (n =29),and found tumor recurrence/metastasis in 1 case (3.3％),2 cases(10％)and 4 cases (13.8％) respectively during the follow-up.The analysis of Kaplan-Meier showed that the recurrence time of DCIS was earlier in high risk group than that in other two groups,and the difference was statistical significance (P =0.003).Conclusions The 12-genes model can preliminarily predict the risk of recurrence in DCIS patients in Chinese.Combined with relevant clinical pathologic factors,it can preferably guide the therapeutic decision-making of DCIS.