目的

探讨基质金属蛋白酶-9(MMP-9)的表达变化以及转移肿瘤周围CD4 ⁺T 细胞/CD8 ⁺T细胞数量和比值在乳腺癌淋巴结转移发展过程中的作用。

方法

收集92 例乳腺癌患者的腋窝淋巴结293枚。采用免疫组化的方法行细胞角蛋白19(CK-19)以及肌动蛋白染色,筛选出含有微转移、孤立肿瘤细胞的淋巴结。对筛选出的淋巴结行MMP-9、CD4 及CD8 染色,观察不同转移情况下MMP-9、CD4 及CD8 的表达情况。

结果

293 枚淋巴结中,明显转移的为84 枚(28.67%),有微转移的为42 枚(14.33%),孤立肿瘤细胞为22 枚(7.51%);所有明显转移灶周围均有肌动蛋白表达,34 枚(80.95%)含有微转移的淋巴结中微转移灶周围有肌动蛋白表达;84 枚有明显转移的淋巴结中,MMP-9 均呈阳性表达,其中66 枚(78.57%)淋巴结高表达(),18 枚(21.43%)为中度表达();42 枚含有微转移的淋巴结中,1 枚(2.38%)呈高表达(),24 枚(57.14%)淋巴结呈中度表达(),15 枚(35.72%)淋巴结呈低表达( +),2 枚(4.76%)淋巴结无表达。22 枚孤立肿瘤细胞中,3 枚(13.64%)呈低表达,其余19 枚(86.36%)淋巴结无表达。CD4 ⁺细胞表达率在有明显转移的淋巴结中明显高于微转移和无转移的淋巴结( P ＜0.05);CD8 ⁺细胞在有明显转移、微转移及无转移淋巴结之间没有明显差异( P ＞0.05)。CD4 ⁺ /CD8 ⁺在无转移的淋巴结明显低于有明显转移者( P ＜0.05)。

结论

MMP-9 的高表达可能是促进淋巴结内肿瘤细胞生长和侵袭的重要原因之一;肿瘤细胞可导致淋巴结癌转移灶局部CD4 ⁺T 淋巴细胞明显增多,导致CD4 ⁺ /CD8 ⁺比值升高,提示机体在淋巴结局部对肿瘤细胞的免疫应答改变可能是肿瘤细胞得以发展的原因之一。

Objective

To explore the expression and significance of MMP-9 and CD4 ⁺ /CD8 ⁺ in lymph node metastasis of breast cancer.

Methods

Two hundred and ninety-three lymph nodes were collected from the axillary samples of 92 cases of breast cancer. The lymph nodes containing metastasis, micrometastases,or ITCS were detected by observing the expression of CK-19 and actin. The expressions of MMP-9, CD4 and CD8 were detected with immuohistochemistry method.

Results

Among the 293 lymph nodes,metastases were found in 84 nodes (28.67%), micrometastases in 42 nodes (14.33%) and ITCs in 22 nodes (7.51%). The expression of MMP-9 was found in all metastasis nodes, and a high expression of MMP-9 was found in 66 nodes (78.57 %).Amany the 42 micrometastastic nodes, a high expression of MMP-9 was found in 1 node (2.38 %), middle expression in 18 nodes (21. 43%), low expression in 15 nodes (35.72%), and no expression in 2 nodes(4.76%). Amany 22 nodes with ITCs, a low expression of MMP-9 was found in 3 nodes. The rate of CD4 ⁺ lymphocyte was significantly higher in metastastic group than in non-metastastic group and in the micrometasatis group( P ＜0.05). There was a significant different rate of CD4 ⁺T/CD8 ⁺T between the metastastic and non-metastastic groups ( P ＜0.05).

Conclusions

The high expression of MMP-9 may enhance the capability of invasion and metastasis of tumor cells. CD4 ⁺ lymphocytes increase on the site of tumor cells in the lymph nodes region, which raises the ratio of CD4 ⁺T/ CD8 ⁺T. The variation of immune response to tumor cells may be one cause to form the metastatic focus.