DNA含量测定在乳腺癌预后判断中的意义

目的应用流式细胞仪（flow cytometry，FCM）回顾性分析预后差的早期乳腺癌及预后好的晚期乳腺癌患者的DNA含量特点，并探讨FCM对预后的应用价值，为临床选择治疗方法提供参考。方法将手术后常规治疗且10年内出现复发、转移甚至死亡的Ⅰ期乳腺癌11例以及术后10年内健在且淋巴结转移10枚以上的Ⅲ期乳腺癌16例分别作为实验组，再从同期患者中选取术后无病生存的Ⅰ期乳腺癌14例以及预后差且淋巴结转移10枚以上的Ⅲ期乳腺癌14例分别作为对照组，应用FCM对各组患者进行DNA含量检测，包括DNA指数（DNA index，DI）、S期分数（SPF）以及DNA倍体。分析比较Ⅰ期及Ⅲ期乳腺癌实验组与对照组DNA含量的特点，并对Ⅲ期乳腺癌患者淋巴结及结外软组织转移水平进行亚组分析。成组设计的计量资料比较采用t检验，多组间的比较采用单因素方差分析，小样本率的比较采用Fisher精确概率法。结果（1）Ⅰ期乳腺癌实验组中异倍体出现率为6／11，二倍体出现率为5／11；Ⅰ期对照组异倍体出现率为0，二倍体出现率为14／14，两组间差异有统计学意义（P=0．003）。（2）分别比较Ⅰ期及Ⅲ期乳腺癌实验组与对照组的DI和SPF，差异均无统计学意义（P〉0．050）。（3）Ⅲ期乳腺癌实验组与对照组的DNA倍体间的差异也无统计学意义（P〉0．050）。（4）Ⅲ期乳腺癌患者第三水平淋巴结转移组二倍体含量高于第一、二水平组，第一、二水平组SPF值低于第三水平组，但组间差异均无统计学意义（P〉0．050）。（5）Ⅲ期乳腺癌患者软组织不同转移水平组间DNA倍体分布的差异无统计学意义（P〉0．050）。结论应用FCM研究早期以及晚期乳腺癌肿瘤的生物学特性，进行DNA含量测定，对临床判断预后，选择治疗方法有一定的指导意义。

Predicting role of DNA content assay in prognosis of breast carcinoma

Objective To retrospectively analyze DNA contents in early breast cancer with bad prognosis and advanced breast cancer with good prognosis using flow cytometry （FCM） and to assess the value of FCM for prognosis of breast cancers, in order to provide a method for clinic choice of appropriate treatment. Methods Patients for this study were randomly selected from those who underwent surgery and conventional treatment in Tianjin Cancer Hospital from January 1990 to December 1992, including 11 patients with clinical stage Ⅰ breast cancer who had recurrence, metastasis or even death in ten years after surgery and 16 patients with clinical stage Ⅲ breast cancer whose positive axillary lymph nodes were more than ten and with ten year disease-free survival after surgery; patients as controls were selected respectively in the same period, including 14 patients with clinical stage Ⅰ breast cancer and with diseasefree survival and 14 patients of clinical stage Ⅲ breast cancer with positive axillary lymph nodes more than ten and with bad prognosis. Then the DNA contents of all samples were tested with FCM, including DNA index （DI）, s phase fraction （SPF） and DNA ploidy. The characteristics of the DNA contents in both groups of clinical stage Ⅰ and Ⅲ breast cancers were analyzed. The levels of lymphatic and soft tissue metastasis of stage Ⅲ breast cancer patients in the subgroups were also analyzed, t test was used for the comparison of quantitation data, single element variance analysis was used for multiple group comparison, and Fisher precise probabilistic method was used for small sample comparison . Results （1） In the group of 11 clinical stage Ⅰ breast cancer patients with bad prognosis, the DNA ploidy was aneuploid in 6 cases（6/l1）, and diploid in 5 （5/11）; in the control group of 14 clinical stage Ⅰ breast cancer patients with ten year disease free survival, the DNA ploidy was aneuploid in zero （0/14） and diploid in all（14/14）, there was statistically significant dif