【摘要】 目的:探索乳腺癌易感基因1(breast cancer susceptibility gene 1,BRCA1)在Ⅲ期胃腺癌中表达及其与患者特异性生存的关系。方法:采用免疫组化EnVision二步法检测300例Ⅲ期胃癌组织中BRCA1蛋白的表达情况,并分析其与预后的关系。结果:胃癌组织中BRCA1蛋白阳性表达率为32.3%(97/300)。BRCA1表达与组织学分级相关,差异有统计学意义(P<0.001)。BRCA1阳性表达的97例患者中,化疗组中位生存期(median survival time, MST)为28.67个月,5年生存率为23.20%;未化疗组MST为17.90个月,5年生存率为17.90%,差异无统计学意义(P=0.526)。BRCA1阴性表达的203例患者中,化疗组MST为24.30个月,5年生存率23.40%;未化疗组MST为18.57个月,5年生存率为6.10%,差异有统计学意义(P=0.006)。Cox多因素分析显示,肿块大小(P=0.001)、淋巴结转移(P<0.001)、化疗与否(P=0.001)为胃癌的独立预后因素。结论:BRCA1阴性表达的胃癌根治术后患者可能从含铂辅助化疗中获益;BRCA1阳性可能是预后良好的指标,但似乎不易从含铂化疗中获益。更多还原

【Abstract】 Objective: To investigate the correlation between BRCA1 expression and the cancer-specific survival of patients with stage Ⅲ gastric adenocarcinoma following surgical resection. Methods: Immunohistochemical EnVision two-step method was used to assess the expression of BRCA1 in resected samples obtained from 300 patients with stage Ⅲ gastric cancer. The relation between BRCA1 expression and survival of patients was analyzed. Results: Among 300 cases, BRCA1 expression was positive in 97 patients(32.3%). BRCA1 expression was significant associated with tumor differentiation(P<0.001). Among patients with BRCA1-positive expression, the median survival time(MST) were 28.67 months in the chemotherapy group and 17.90 months in the control group; the 5-year overall survival rates were 23.20% in the former and 17.90% in the latter, and the difference was not statistically significant(P=0.526). Among patients with BRCA1-negative tumors, the MST were 24.30 months in the chemotherapy group and 18. 57 months in the control group; the 5-year overall survival rates were 23.40% in the former and 6.10% in the latter, and the difference was statistically significant(P=0.006). Multivariate COX analysis showed that tumor size(P=0.001), lymph node metastasis(P<0.001) and chemotherapy(P=0.001) were independent prognosis factors for gastric cancer. Conclusion: After radical resection of gastric cancer, patients with BRCA1-negative expression may benefit from platinum-based adjuvant chemotherapy. However BRCA1-positive expression could be a good prognostic factor in patients without adjuvant chemotherapy.更多还原