Contrastive Analysis On The Risk Factors Of Axillary Lymph Node Metastasis And Prognosis Between Uygur And Han Patients With Breast Cancer In Xinjiang

Objective：1) Comparatively analyse and research the clinical and pathologicalparameters between Xinjiang Uygur and Han women with breast cancer, to explore thedifference of possible risk factors in Xinjiang Uygur and Han women with breast cancerwhich could affect the metastasis of axillary lymph node, by which we could lay thefoundation of establish interventions, develop individualized treatment, judge prognosisand select the correct adjuvant therapy;2) Comparatively analyse and research thedifferent expression of Axl and its ligand protein Gas6in benign and malignant breasttissue of Xinjiang Uygur and Han women,and the different expression of axillary lymphnode metastasis group and without metastasis group. Explore the relationship of Axl, Gas6expression with benign and malignant breast tumors and relationship of axillary lymphnode metastasis;3) By analyzing the expression of Axl and its ligand protein Gas6inbenign and malignant breast tissues,to explore its clinical pathological significance and itsrelationship with the prognosis of breast cancer.Methods:1) In the past three years, theclinical and pathological datas of new onset T1stage Uygur and Han female breast cancerpatients were collected, detect the immunohistochemistry indicators of ER, PR, Her-2,nm23and Ki67expression in Uygur and Han female breast cancer patients,comparativelyanalyse the differences of clinical and pathological datas in Uygur and Han patients, thenthe univariate and multivariate unconditional logistic regression were used to analyse therisk factors which could affect axillary lymph node metastasis in Xinjiang Uygur and Hanpatients with breast cancer;2) Fresh tissues samples of cancer and paracancerous in22Uygur and33Han recent onset women patients with breast cancer and the fresh tissues ofother20benign control cases were collected,the clinical data were collected too, by usingWestern-blot and immunohistochemical PV-9000method the expression of Axl and itsligand Gas6were detected respectively in Uygur and Han breast cancer tissue,paracancerous tissures and normal benign tissues;to analyze the expression levels between the different ethnic groups and between benign and malignant tumors,to analyze thecorrelationship of Axl and Gas6expression level with axillary lymph node metastasis;3)from January2006to January2007,a total of252cases of stage Ⅰ~Ⅲbreast cancerpatients were retrospectively analysed in our hospital,all the patients were admitted tosurgery and the clinical and pathological datas were completely collected. The expressionof Axl and Gas6in252patients with breast cancer were detected by immunohistochemicalPV-9000method, the the relationship of its expression with clinical pathologicalparameters and prognosis were analysed; Results:1) The axillary lymph node metastasisrates are43.94%and30.86%in T1stage Uygur and Han women with breast cancerrespectively,and the difference is statistically significant (P<0.05); the times of pregnancy,whether breastfeeding, breastfeeding duration is statistically significant in Stage T1Uygurand Han women with breast cancer (P<0.05);the number of Uygur women pregnancytimes, breastfeeding and duration of breastfeeding are higher than Han patients; the Her-2and Ki67expression between the two groups is statistically significant (P<0.05), in Hangroup, Her-2positive expression rate is9.9%, while in Uygur group Her-2positiveexpression rate is21.2%,the Ki67positive expression rate in Uygur group was62.1%, inHan group is75.3%; multivariate logistic regression analysis showed that the times ofpregnancy, histological grade are the risk factors to predict the axillary lymph nodemetastasis in Xinjiang Uygur and Han patients with breast cancer (P<0.05), and ERpositive expression is the protective factors (P<0.05);2) Western-blot andimmunohistochemistry results shows that expression levels of Axl and Gas6are differentin benign, malignant and normal control tissues, in breast cancer tissues the expression issignificantly higher than the corresponding paracancerous tissues and normal controltissues,the difference is statistically significant (P<0.05), but in paracancerous tissues andbenign breast hyperplasia the difference has no statistical significance (P>0.05); Theexpression differences of Axl and Gas6in cancer tissues, paracancerous tissues andnormal control tissues between Uygur and Han are comparatively analysed,the resultsshow that the difference of inter-ethnic tissues Axl and Gas6protein expression is notstatistically significant (P>0.05), but the expression level of Axl and Gas6protein inlymph node metastasis group is higher than the group without metastasis,the difference isstatistically significant (P<0.05);3) In breast cancer tissures the positive expression rate ofAxl is63.5%, significantly higher than the28.6%of the normal control tissues, thedifference is statistically significant (P<0.05); Gas6positive expression rate in the cancertissue is47.6%,significantly higher than the23.8%of the normal control group, the difference is statistically significant too (P<0.05). Between different ethnic groups,different age groups, different types of pathology and molecular type group the expressionof Axl and Gas6has no significant difference (P>0.05); with the increased tumor T stageand histological grade, the positive expression rate of Axl and Gas6are graduallyincreased,the differences are statistically significant (P<0.05); Axl and Gas6positiveexpression rate in lymph node metastasis group are70.4%and56.3%higher than that thethe50.9%and36.4%in the group without lymph node metastasis, the difference hasstatistically significant (P<0.05); in Vascular infiltration group Axl and Gas6positiveexpression rate is significantly higher than the non-invasive group, the difference isstatistically significant (P<0.05); single factor Kaplan-Meier survival analysis shows thatlymph node metastasis, histological grade, vascular infiltration, molecular typing and Axlexpression are related to the5years tumor-free survival rate in breast cancer patients(P<0.05),multivariate Cox regression analysis show that high histological grade, Axlpositive expression and axillary lymph node metastasis are the independent prognosticindicator of5years tumor-free survival rate for breast cancer patients afteroperation.Conclusions:1) The axillary lymph node metastasis rate of T1stage Uygurfemale breast cancer patients is higher than the Han patients; more pregnancy times,poorer histological grading is the risk factors for predict the axillary lymph nodemetastasis in Xinjiang Uygur and Han patients with breast cancer,and the ER positiveexpression is the protective factors;2) The expression of Axl and Gas6in breast cancertissue is significantly higher than paracancerous tissures and normal control tissue; theexpression of Axl and Gas6in Xinjiang Uygur and Han nationality had no differencebetween breast cancer tissues, paracancerous tissures and normal control tissue; Axl andGas6expression level in lymph node metastasis group is higher than that withoutmetastasis group suggesting Axl and Gas6expression promote breast cancer axillarylymph node metastasis;3) Axl and Gas6expression levels is closely related to tumor Tstage, histological grading, axillary lymph node metastasis and vascular invasion; Axlpositive expression group5years tumor-free survival rate is poor; Axl and Gas6areclosely related to the occurrence and development in breast cancer; Axl positiveexpression,axillary lymph node metastasis and poorer histological grading wereindependent poor prognostic indicator for breast cancer.