复发转移性乳腺癌mdr-1基因产物P-糖蛋白表达的临床意义

目的　探讨复发转移性乳腺癌mdr 1基因表达产物P 糖蛋白 (P glycoprotein ,P gp)表达及其与含吡喃阿霉素联合方案化疗疗效的关系。方法　应用SABC法检测 4 6例转移性乳腺癌术后组织中P gp表达 ,使用环磷酰胺、吡喃阿霉素和 5 氟尿嘧啶联合方案化疗 ,对比分析P gp表达与疗效的关系。 结果　① 4 6例患者mdr 1基因表达产物P gp阳性表达率 5 6 .5 % ,肝或肺转移者阳性表达明显高于皮肤或淋巴结转移者 (P =0 .0 4 9)。②可评价疗效的 4 3例患者化疗有效率 5 8.1% ;P gp阴性组疗效 (89.5 % )明显优于P gp阳性组 (30 .0 % ) (P <0 .0 1)。③有肝或肺转移者有效率(4 0 .7% )明显低于皮肤或浅表淋巴结转移者 (87.5 % ) (P <0 .0 5 )。④术后曾接受辅助性CAF或CMF方案化疗者复发转移后化疗疗效 (71.4 %和 37.5 % )无显著性差异 (P =0 .0 5 2 )。结论　mdr 1基因表达产物P gp表达阳性者应选择非MDR型药物的联合方案化疗

Clinical significance of mdr-1 gene product P-glycoprotein expression in recurrent and metastatic breast carcinoma

Objectives To study P-glycoprotein (P-gp), the mdr-1 gene product, expression and response to pirarubicin containing regimen in recurrent and metastatic breast carcinoma. Methods P-gp expression in 46 postoperative patients with recurrent and metastatic breast carcinoma was detected by SABC immunohistochemical method. These patients were treated with combination regimen of cyclophosphamide, pirarubicin and 5-fluorouracil. The correlation between P-gp expression and chemotherapeutic response was analyzed. Results ① The positive rate of P-gp's expression was 56.5% in 46 postoperative patients with recurrent and metastatic breast carcinoma, the P-gp expression in the patients with lung or liver metastasis was higher than that in skin or lymph node metastasis (P=0.049). ②The overall response rate was 58.1% in 43 patients; the response rate (89.5%)of the P-gp negative group was higher than that (30.0%)of the P-gp positive group (P<0.01). ③The response rate (87.5%) in the patients with skin or lymph node metastasis was higher than that (40.7%) of the patients with lung or liver metastasis (P<0.05). ④In the postoperative patients who had received CAF or CMF regimen adjuvant chemotherapy previously, the response rate of metastatic diseases to chemotherapy had no significant difference (71.4% and 37.5%, respectively) (P=0.052). Conclusion Patients with P-gp positive recurrent and metastatic breast carcinoma should be treated with chemotherapy combined with non-MDR drug.