目的：观察乳腺导管内癌（ductal carcinoma in situ，DCIS）中 Ki-67的表达情况及其与不同组织学分级及分子分型之间的关系。方法采用免疫组织化学 EnVision 两步法检测60例 DCIS 组织中雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体（HER-2）、增殖细胞核杭原 Ki-67的表达，按照免疫表型分为4种类型：腺腔 A型[（ER（＋）和（或）PR（＋）、HER-2（－）、Ki-67低表达（＜14％）]、腺腔 B 型[分为 HER-2（＋）和 HER-2（－）型， HER-2（－）型：ER（＋）和（或）PR（＋）、HER-2（－）、Ki-67高表达（≥14％）；HER-2（＋）型：ER（＋）和（或）PR（＋）、HER-2（＋）、Ki-67任何水平]、HER-2过表达型[ER（－）、PR（－）、HER-2（＋）]和三阴型[ER（－）、PR（－）、HER-2（－）]。比较 Ki-67表达与 DCIS 组织学分级及分子分型的关系。结果Ki-67在低级别至高级别 DCIS 中的表达依次增高，差异有统计学意义（P ＜0．01）。Ki-67在腺腔 A 型、腺腔 B 型、三阴型、HER-2过表达型中的表达依次升高，差异有统计学意义（P ＜0．01）。DCIS 分子分型与组织学分级有关联（P ＜0．01），腺腔 A 型和腺腔 B 型以低、中级别 DCIS 为主，三阴型及 HER-2过表达型以高级别 DCIS 为主。结论Ki-67是 DCIS 一项重要的预后指标， Ki-67纳入分子分型指标进一步对腺腔 A 型及腺腔 B 型 DCIS 进行分型是对单纯用 ER、PR、HER-2进行分型的完善和补充，有利于临床实施有效的个体化治疗方案。%ABSTRACT:Objective To observe the expression of Ki-67 in ductal carcinoma in situ(DCIS) and its relationships to histological grade and molecular classification.Methods The expression of estrogen receptor(ER),progesterone receptor(PR),Ki-67 and HER-2 was detected in 60 cases of DCIS by using immunohistochemistry(EnVision method).According to the immunopheno-types,four subtypes were classified:luminal A subtype[ER(+)/PR(+),HER-2(-),Ki-67 ex-pression<14%),luminal B subtype(HER-2(-)subtype:ER(+)/PR(+),HER-2(-),Ki-67 ex-pression≥14%;HER-2(+)subtype:ER(+)/PR(+),HER-2(+),any Ki-67 expression),HER-2-overexpressing subtype(ER(-),PR(-),HER-2(+)],and triple negative subtype[ER(-), PR(-),HER-2(-)].The relationships of Ki-67 expression to histological grade and molecular classification of DCIS were analyzed.Results The expression of Ki-67 significantly increased from low to high histological grade of DCIS(P <0.01).Moreover,Ki-67 expression successively increased in luminal A subtype,luminal B subtype,triple negative subtype and HER-2-overex-pressing subtype of DCIS(P <0.01).The molecular classification of DCIS was related to the his-tological grade(P <0.01).Low-and middle-grade DCIS were predominant in luminal A subtype and luminal B subtype.But high-grade DCIS was predominant in HER-2-overexpressing subtype and triple negative subtype.Conclusion Ki-67 is an important prognostic indicator in DCIS.New molecular classification including Ki-67 as an index is a supplement for the classification of lumin-al A subtype and luminal B subtype of DCIS with ER,PR and HER-2.It is advantageous for clini-cal implementation of individualized treatment regimen.
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