目的 探讨p53、c-erbB-2和组织蛋白酶D(cathepsinD)在评估腋窝淋巴结阴性乳腺癌（NNBC）患者预后中的价值。 方法 用免疫组化方法，检测110例T1-2N0M0期乳腺癌患者原发灶癌组织中p53、c-erbB-2和cathepsinD水平；并用单因素和多因素统计方法对其结果与肿瘤的临床特性及患者预后之间的关系进行了分析。 结果 本组肿瘤直径＞3cm的患者比＜3cm患者的远处转移率高，无瘤生存率和总生存率下降，差异有显著性意义（分别P＜0.05、P＜0.01、P＜0.05）；cathepsin阴性患者的肿瘤远处转移率、无瘤生存率、分别为8.25%、82.61%，阳性患者为33.06%、57.41%，差异均有极显著性意义（P＜0.01）；c-erbB-2阴性患者及p53表达状态与患者的肿瘤远处转移率、无瘤生存率和总生存率无关。62例未作全身治疗的患者，cathepsin阴性患者的肿瘤远处转移率、无瘤生存率、分别为8.92%、77.04%，阳性患者为44.61%、43.46%，差异均有极显著性意义（P＜0.01）；c-erbB-2阴性患者的肿瘤远处转移率、无瘤生存率、和总生存率分别为16.70%、70.11.%、88.30%；阳性患者为41.26%、44.44%、68.65%，差异均有显著性意义（P＜0.05）；53表达状态与患者的肿瘤远处转移率、无瘤生存率和总生存率无关；多因素分析表明肿瘤大小和cathepsinD表达水平与患者的远处转移率、无瘤生存率有关（P＜0.05）。48例接受全身治疗的患者p53、c-erbB-2及cathepsinD的表达状态与患者预后无关。 结论 肿瘤大小和cathepsinD水平可作为评估腋窝淋巴结阴性乳腺癌患者预后的独立指标，对患者治疗方案的选择具有一定的指导意义。%Objective To determine the prognostic value of p53,c-erbB-2 andcathepsin D overexpression in patients with node-negative breast carcinoma (NNBC). Methods Expression of p53, c-erbB-2 and cathepsin D was measured immunohistochemically in primary tumors of 110 node-negative breast cancer patients with T1-2. Data were analyzed by both univariate and multivariate statistical analysis to find out their relation to local, regional recurrence, distant metastasis, relapse-free survival (RFS) and overall survival (OS) rates. Results Univariate analysis showed that tumor size is an important clinical prognostic factor related to distant metastasis, RFS, and OS. Overexpression of c-erbB-2 and cathepsin D were significantly associated with both distant metastasis and RFS by univariate analysis. In multivariate analysis, tumor size and cathepsin D were significant and independent factors for distant metastasis and RFS, and tumor size was independently associated with OS. P53 expression was not associated with prognosis as shown by either univariate or multivariate analysis. Conclusion Tumor size and cathepsin D are independent prognostic indicators of failure, which are useful in selection of high-risk NNBC patients for adjuvant therapies.
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