摘要
目的 探讨人类表皮生长因子受体-2(Her-2)、表皮生长因子受体(EGFR)、肿瘤增殖细胞抗原(Ki67)联合检测评价乳腺癌手术的效果及对预后的预测分析.方法 回顾性选取2019年2月至2022年2月西安市人民医院(西安市第四医院)收治的80例乳腺癌患者作为研究对象.所有患者均采取乳腺癌改良根治术治疗,术后进行2年随访,依照随访结果将患者分为预后良好组(n=60)与预后不良组(n=20).比较手术前后两组患者Her-2、EGFR、Ki67表达水平.建立受试者操作特征(ROC)曲线,分析术后Her-2、EGFR、Ki67联合检测对乳腺癌预后不良的诊断价值.对比两组的临床一般情况,并采用多因素Logistics回归模型分析影响乳腺癌预后不良的因素.结果 手术前,预后不良组Her-2、EGFR、Ki67阳性率分别为75.00％、80.00％、63.33％,均明显高于预后良好组(36.67％、41.67％、63.33％),术后2年,预后不良组Her-2、EGFR、Ki67阳性率分别为50.00％、65.00％、70.00％,均明显高于预后良好组(8.33％、5.00％、16.67％),差异均有统计学意义(P＜0.05).术后2年,Her-2、EGFR、Ki67联合检测乳腺癌预后不良的敏感度、特异度、曲线下面积(AUC)分别为92.46％、84.68％和0.876,预测价值较好(P＜0.05).预后良好组与预后不良组患者年龄、是否绝经、病理类型、肿瘤大小比较,差异均无统计学意义(P＞0.05);预后良好组与预后不良组患者临床分期、组织分化程度、淋巴结转移、治疗前血红蛋白水平比较,差异均有统计学意义(P＜0.05).多因素Logis-tic 回归模型结果显示,手术前Her-2、EGFR、Ki67阳性表达、临床分期、组织分化程度、淋巴结转移均为乳腺癌预后独立危险因素(P＜0.05).结论 Her-2、EGFR、Ki67联合检测对乳腺癌预后不良具有较高敏感度和特异度,且Her-2、EGFR、Ki67阳性表达对乳腺癌预后不良具有重要的预测价值.
Abstract
Objective To explore the combined detection of human epidermal growth factor receptor-2(Her-2),epidermal growth factor receptor(EGFR),and tumor proliferating cell antigen(Ki67)to evaluate the surgical effect and prognosis of breast cancer.Methods Eighty patients with breast cancer admitted to Xi'an People's Hospital(Xi'an Fourth Hospital)from February 2019 to February 2022 were selected as the study subjects.All patients were treated with modified radical mastectomy for breast cancer.All patients were followed up for 2 years after surgery.According to the follow-up results,the patients were divided into the good prognosis group(n=60)and the bad prognosis group(n=20).The expression levels of Her-2,EGFR and Ki67 were compared before and after surgery.The diagnostic value of combined detection of Her-2,EGFR and Ki67 for poor prognosis of breast cancer was analyzed by establishing receiver operating characteristic(ROC)curve.The clin-ical general conditions of the two groups were compared.With the prognosis as the dependent variable,the independent risk factors of poor progno-sis in breast cancer were analyzed by multivariate Logistics regression model.Results The positive rates of Her-2,EGFR,and Ki67 in the poor prognosis group before surgery were 75.00％,80.00％,and 63.33％,respectively,which were significantly higher than those in the good prog-nosis group(36.67％,41.67％,63.33％),the positive rates of Her-2,EGFR,and Ki67 in the poor prognosis group 2 years after surgery were 50.00％,65.00％,and 70.00％,respectively,which were significantly higher than those in the good prognosis group(8.33％,5.00％,16.67％),the differences were statistically significant(P＜0.05).The sensitivity,specificity and area under the curve(AUC)of 2 years after surgery Her-2,EGFR and Ki67 combined detection of poor prognosis of breast cancer were 92.46％,84.68％and 0.876,respectively,with good predictive value(P＜0.05).There were no statistically significant difference in age,menopause,pathological type,and tumor size between the group with good prognosis and the group with poor prognosis(P＞0.05).However,there were statistically significant differences in clinical stage,tissue differentiation,lymph node metastasis,and pre-treatment hemoglobin levels between the group with good prognosis and the group with poor prognosis(P＜0.05).The results showed that the positive expression of Her-2,EGFR,Ki67,clinical stage,tissue differentiation,and lymph node metastasis before surgery were independent prognostic risk factors of breast cancer(P＜0.05).Conclusion The combined de-tection of Her-2,EGFR and Ki67 has high sensitivity and specificity for poor prognosis of breast cancer,and the positive expression of Her-2,EGFR and Ki67 have important predictive value for poor prognosis of breast cancer.
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