Expression of BCL-2 in node-negative breast cancer is associated with various prognostic factors, but does not predict response to one course of perioperative chemotherapy
Expression of BCL-2 in node-negative breast cancer is associated with various prognostic factors, but does not predict response to one course of perioperative chemotherapy
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DOI：
10.1038/bjc.1996.319
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发表时间：
1996-07-01
影响因子：
8.8
通讯作者：
vandeVijver, MJ
中科院分区：
文献类型：
--
作者：
vanSlooten, HJ;Clahsen, PC;vandeVijver, MJ
本研究的目的是评估绝经前淋巴结阴性乳腺癌患者Bcl-2表达、化疗反应和一些病理学和生物学肿瘤参数之间的关系。在一系列441例绝经前淋巴结阴性乳腺癌患者的石蜡包埋切片上，采用免疫组织化学法测定Bcl-2的表达，这些患者随机接受围手术期化疗（5-氟尿嘧啶、阿霉素、环磷酰胺）或不接受围手术期化疗。Bcl-2的免疫组化通过对染色强度（0-3）和阳性细胞数（0-2）进行评分来评价。使用这些评分将肿瘤分为0-6类。结果发现，9.2%的谣言是完全阴性（0），17.2%弱（1 + 2），41.6%中度（3 + 4）和31.9%强阳性（5 + 6）的Bcl-2。Bcl-2高表达与雌激素水平呈正相关孕激素受体阳性（P < 0.001）（P < 0.001）和低肿瘤分级Bcl-2高表达与p53表达呈负相关（P < 0.001 c-er B-B-2阳性（P <0.001）、Ki-67指数高（P <0.001）、核分裂指数高（P <0.001）、肿瘤体积大（P = 0.006）。Bcl-2表达水平高的肿瘤患者（总评分3-6）的无病生存率（P = 0.004）和总生存率（P = 0.009）显著更高。然而，在多变量模型中，这种关联不再保持显著性。在中位随访49个月时，对于Bcl-2阳性（HR-0.61，95% CI 0.35-1.06，P = 0.07）和阴性（HR = 0.55，95% CI 0.27-1.12，P = 0.09）乳腺肿瘤患者，辅助化疗对无病生存期的影响存在趋势。Bcl-2表达水平似乎不能预测绝经前淋巴结阴性乳腺癌患者围手术期化疗的反应。高水平的Bcl-2优先在分化良好的肿瘤中表达，并与良好的预后相关。然而，Bcl-2的表达是不是一个独立的预后因素，在这个病人系列。
The aim of this study was to assess relationships between Bcl-2 expression, response to chemotherapy and a number of pathological and biological tumour parameters in premenopausal, lymph node-negative breast cancer patients. Expression of Bcl-2 was determined using immunohistochemistry on paraffin-embedded sections in a series of 441 premenopausal, lymph node-negative breast cancers of patients randomised to receive perioperative chemotherapy (5-fluorouracil, doxorubicin, cyclophosphamide) or no perioperative chemotherapy. Immunohistochemistry of Bcl-2 was evaluated by scoring both staining intensity (0-3) and number of positive cells (0-2). Using these scores tumours were grouped into categories 0-6. It was found that 9.2% of the rumours were completely negative (0), 17.2% weakly (1 + 2), 41.6% moderately (3 + 4) and 31.9% strongly positive (5 + 6) for Bcl-2. A positive correlation was found between high Bcl-2 expression and oestrogen (P < 0.001) and progesterone receptor positivity (P < 0.001) and low tumour grade (P < 0.001), whereas high Bcl-2 expression was negatively correlated with p53 (P < 0.001) and c-erb-B-2 positivity (P < 0.001), high Ki-67 index (P < 0.001), mitotic index (P < 0.001) and large tumour size (P = 0.006). Patients with tumours expressing high levels of Bcl-2 (overall score 3-6) had a significantly batter disease-free (P = 0.004) and overall (P = 0.009) survival. However, in a multivariate model this association no longer remained significant. There was a trend for an effect of adjuvant chemotherapy on disease-free survival both for patients with Bcl-2-positive (HR-0.61, 95% CI 0.35-1.06, P = 0.07) and negative (HR = 0.55, 95% CI 0.27-1.12, P = 0.09) breast tumours at a median Follow-up of 49 months. The level of Bcl-2 expression does not seem to predict response to perioperative chemotherapy in premenopausal, lymph node-negative breast cancer patients. High levels of Bcl-2 are preferentially expressed in well-differentiated tumours and are associated with favourable prognosis. However, Bcl-2 expression is not an independent prognostic factor in this patient series.