| Objective:To retrospectively analyze cases of triple-negative breast cancer which were diagnosed in Fuzhou General Hospital of Nanjing Military Command 102 cases, and then (1)investigate the expression of TGF-β1 and E-cadherin in triple-negative breast cancer and its Sub type basal-like breast cancer and non-basal-like breast cancer, the correlations between TGF-β1 and E-cadherin expression and its interrelationship with clinicopathological parameters and survival prognosis. (2)Explore the TCM constitution types distribution of patients with triple negative breast cancer, analyze the relationship between the TCM constitution types and TGF-β1 and E-cadherin expression and the correlation between different TCM constitution types and survival prognosis.Methods:(1)Accordance with the exhaust standard Strictly to collect specimens from patients with triple-negative breast cancer who were diagnosed by Department of Pathology of Fuzhou General Hospital of Nanjing Military Region. (2)To detect TGF-β1 and E-cadherinthe expression using immunohistochemistry. (3)Collect Clinicopathological parameters of patients enrolled and follow-up their survival prognosis. (4)Investigate and classify these patients’ TCM constitution types using "Chinese constitution classification and decision tables" that is formulated by Chinese Medical Association’s, (5)Collate the information and then analyze the relationship between TGF-β1/E-cadherin expression and clinicopathological parameters, survival prognostic and TCM constitution types with triple-negative breast cancer and its Sub type basal-like breast cancer and non-basal-like breast cancer using SPSS 16.0 statistical software.Results:1、In Triple negative breast cancer:(1) the positive expression rates of TGF-β1 and E-cadherinwas was 61.8% and 36.3%, respectively, and there is a negative correlation between them (r=-0.330, P=0.001, P<0.05).(2)The expression of TGF-β1 was associated with lymphatic metastasis (P= 0.050, P<0.05), while E-cadherin expression is related to menopausal state (P= 0.016, P<0.05).(3) The rate of local recurrence and/or distant metastasis in TGF-β1-positive group was 50.8% (32/63) which is significantly higher than that in the negative group 12.8% (5/39), and the difference was statistically significant (P= 0.000, P<0.05), the rate of local recurrence and/or distant metastasis in E-cadherin positive group was 27.0%, lower than that in the negative group 41.5%(27/65), but there was no significant difference between the two groups (P= 0.143, P> 0.05).(4) Univariate analysis revealed that the survival curves of TGF-β1 positive and negative groups separated, the 3-year DFS of TGF-β1 positive group was significantly lower than that of the negative group (P= 0.000, P<0.05),3-year DFS of patients was also related to lymphatic metastasis, histological grade and tumor stage (P<0.05); further multivariate analysis showed that TGF-β1 positive may be independent prognostic risk factor of prognostic triple-negative breast cancer patients (P= 0.001, P<0.05).(5)Combined detection of TGF-β1 and E-cadherin revealed that the rate of local recurrence and/or distant metastasis in TGF-β1-positive and E-cadherin negative group was 52.1%(25/48), significantly higher than that in TGF-β1 negative and E-cadherin positive group 13.6% (3/22), univariate analysis showed significant differences in patients’ DFS into four combinations,in which TGF-β1 and E-cadherin combined detection.(P= 0.000, P<0.05).2> In the subgroup of tripe negative breast cancer, namely basal-like breast cancer and non-basal-like breast cancer:(1)the positive expression rate of TGF-β1/E-cadherin was 77.2% and 42.2%/26.3% and 48.9%. Different expression of TGF-β1 and E-cadherin between the two groups was statistically significant (P= 0.000, P= 0.019, P<0.05); rank correlation analysis showed negative relation between TGF-β1 and E-cadherin in basal-like breast cancer (r=-0.435, P= 0.001, P<0.05).(2) there was significant difference (P= 0.034, P<0.05) between TGF-β1 expression and histological grade in the non-basal-like breast cancer; there are significant differences between E-cadherin expression and menopausal state in basal-like breast cancer and non-basal-like breast cancer(P= 0.009, P= 0.004, P<0.05).(3) Univariate analysis didn’t found correlation (P> 0.05)between E-cadherin expression and 3-year DFS in two groups, while in non-basal-like breast cancer13-year DFS was related to expression of TGF-β1 (P= 0.000, P<0.05), also related to age, metastasis lymphatic, histological grade and tumor stage (P= 0.000, P= 0.000, P= 0.004, P= 0.000, P<0.05). Further multivariate analysis indicated TGF-β1 may be a independent prognostic risk factor of non-basal-like breast cancer (P= 0.033, P<0.05).3-. According to the analysis of TCM constitution questionnaire survey, among the triple-negative breast cancer patients, the main physical types are Qi-stagnation type, blood stasis type, phlegmatic hygrosis type and damp-heat type. The expression of E-cadherin is associated with the Qi-stagnation constitution (P= 0.011, P<0.05). Univariate Kaplan-Meier analysis indicates that types of TCM constitutions are not correlated with the prognosis of triple-negative breast cancer (P=0.318, P>0.05).Conclusion(1) The positive expression rate of TGF-β1 and E-cadherin in triple-negative breast cancer is 61.8% and 36.3%, respectively, and the correlation between them was negative; The expression of TGF-β1 was associated with lymphatic metastasis, while E-cadherin expression was related to menopausal state; recurrence and/or distant metastasis in TGF-β1 positive group appeared significantly higher than that in the negative group, recurrence and/or distant metastasis in E-cadherin positive group appeared lower than that in negative group, but there were no significant difference between the two groups; univariate analysis displayed that 3-year DFS was relevant to lymphatic metastasis, histological grade, tumor stage and TGF-β1 expression (P<0.05),3-year DFS of patients in TGF-β1-positive group was significantly worse than the negative group, multivariate analysis showed that TGF-β1 expression may be an independent prognostic factor of triple-negative breast cancer (P<0.05).(2) In the subgroup of tripe negative breast cancer, namely basal-like breast cancer and non-basal-like breast cancer, the positive expression rate of TGF-β1 and E-cadherin was 77.2% and 42.2%/26.3% and 48.9%. Different expression of TGF-β1 and E-cadherin between the two groups was statistically significant, and there showed a negative relation between TGF-β1 and E-cadherin in basal-like breast cancer. TGF-β1 expression was associated with the histological grade of the non-basal-like breast cancer; while the expression of E-cadherin showed correlation with menopausal state in both basal-like and non-basal-like breast cancer.Univariate analysis didn’t found correlation between E-cadherin expression and 3-year DFS in two groups, while in non-basal-like breast cancer,3-year DFS was related to expression of TGF-β1, also related to age, metastasis lymphatic, histological grade and tumor stage. Further multivariate analysis indicated TGF-β1 may be an independent prognostic factor of non-basal-like breast cancer(3) In terms of TCM constitution types, the majority of physical types of the triple-negative breast cancer patients are Qi-stagnation type and blood stasis type, the expression of E-cadherin is associated with the Qi-stagnation constitution, Univariate analysis revealed that there is no certain correlation between TCM constitution types and 3-year DFS (P>0.05). |
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