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[摘要] 目的 探讨外周血CK-19 mRNA表达与乳腺癌的关系,评价其在乳腺癌诊断上的价值。方法 应用RT-PCR技术检测200例乳腺癌患者外周血中CK-19 mRNA表达情况,并以66例乳腺良性疾病和60例正常健康女性作为对照。结果 200例乳腺癌患者48例外周血CK-19为阳性,66例乳腺良性疾病患者中3例阳性,而同时检查的60位健康者,他们的外周血CK-19均为阴性;不同年龄病人的CK-19检测阳性率对比,彼此之间差异无统计学意义;肿瘤不同分期CK-19阳性率对比差异有统计学意义。结论 RT-PCR法检测CK-19 mRNA可作为乳腺癌诊断的指标。
[关键词] 乳腺癌; CK-19 mRNA; 逆转录聚合酶链反应(RT-PCR)
[中图分类号] R737.9 [文献标识码] A [文章编号] 1673-9701(2009)33-15-02
Clinical Significance of CK-19 mRNA in Patients with Breast Cancer
MENG Fanjie WANG Yufang WANG Guofeng
Yidu Central Hospital of Weifang City,Qingzhou 262500,China
[Abstract] ObjectiveTo investigate the clinical significance of CK-19 mRNA in patients with breast cancer. MethodsThe CK-19 mRNA expression in the peripheral blood of 20 cases of breast cancer was measured by using RT-PCR method before operation,and 66 patients with benign breast diseases and 60 healthy women were taken as controls. ResultsThe positive rates of CK-19 mRNA in patients with breast cancer and benign breast diseases were 24%(48/200)and 4.54%(3/66),respectively,and CK-19 mRNA was all negative in the 60 healthy women. Thepositive rate difference between the breast cancer group and the control group was significant(P
2 结果
不同研究对象及乳腺癌不同年龄、不同分期CK-19检测结果见表1。
3 讨论
细胞角蛋白(cytokeratin,CK)是一类细胞结构蛋白的总称,根据相对分子质量、等电点等不同可分为1~20种片段,CK-19是上皮细胞骨架的组成成分,也是上皮来源恶性肿瘤细胞中间丝的组成成分,在正常的外周血、骨髓及淋巴结中无表达,是具有高度组织特异性和在乳腺癌细胞中广泛表达的细胞角蛋白,是检测乳腺癌微转移最有价值的标记物[2,3]。
3.1 检测外周血CK-19的临床意义
通过检测外周血CK-19来判断外周血里是否有上皮细胞或上皮细胞的成分,以判断是否有上皮来源的乳腺肿瘤细胞存在。本次观察的对象中,乳腺癌组与对照组阳性率比较有显著性差异(60岁的CK-19阳性率相似,他们之间并无统计学差异。因此,CK-19的阳性率与年龄无关。
乳腺肿瘤的大小是乳腺癌分期的一个重要的指标,也是决定乳腺癌预后的因素之一。根据世界卫生组织(WHO)1997年乳腺癌分期:导管内癌或湿疹样癌为Tis,肿瘤5cm为T3期,肿瘤侵犯皮肤或胸壁为T4期。本研究发现T1、T2期乳腺癌的CK-19阳性率无统计学意义,而T3的阳性率明显高于前两期,有统计学意义。由此说明随着肿瘤数目的增多及体积的增大,其血行转移的可能性就增加,特别是肿瘤大于5cm后,血行转移明显增加。同时也说明无论肿瘤有多大,都有可能出现血行播散(由于本研究中仅有4例导管内癌,尚无法证明Tis的肿瘤是否会存在血行播散的可能,这还有待更多的病例进行进一步的研究,从而也说明了为何仍有部分早期的乳腺癌病人会出现远处转移。
[参考文献]
[1] Grunewald K,Haun M,Urbanek M,et al. Mammaglobin gene expression:a superior marker of breast cancer cells in peripheral blood in comparison to epidermal-growth-factor receptor and cytokeratin-19[J]. Lab Invest,2000,80(7):1071-1077.
[2] Schoenfeld A,Kruger KH,CommJ,et al. The detection of micrometastasis in the peripheral blood and bone marrow of patients with breast cancer using immunohistochemistry and reverse transcriptase polymerase chain reaction for keratin 19[J]. Eur J Cancer,1997,33(6):854-861.
[3] Zhang J,Shen K W,Liu G,et al. Antigenic profiles of disseminated breast tumor cells and microenvironment in bone marrow[J]. Eur J Surg Oncol,2003,29(2):121-126.
[4] Ko Y,Grunewald E,Totzke G,et al. High percentage of false-positive results of cytokeratin 19 RT-PCR in blood:a model for the analysis of illegitimate gene expression[J]. Oncology,2000,59(1):81-88.
(收稿日期:2009-02-23)
