不同分子亚型乳腺癌的临床特征和预后  

Clinical characteristics and prognosis of different subtypes of breast cancer

作　　者：袁中玉[1] 王树森[1] 朱美琴[1] 郑磊[1] 罗文标[1] 周中梅[1] 管忠震[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心内科,广州510060

出　　处：《中华肿瘤杂志》2008年第6期456-461,共6页Chinese Journal of Oncology

摘　　要：目的分析Basal—like型、HER-2型和Luminal型乳腺癌患者的临床特征和预后，为乳腺癌的个体化治疗提供依据。方法根据患者雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER-2）的免疫组化结果，将1280例可手术乳腺癌患者分为Basal-like型、HER-2型和Luminal型3组，回顾性分析不同亚型乳腺癌的临床特征、复发转移及生存情况。结果1280例乳腺癌患者中，Basal-like型、HER-2型和Luminal型乳腺癌分别占20．9％、23．2％和55．9％。Basal-like型乳腺癌年轻患者所占比例较大，〈35岁者占13．4％；有乳腺癌家族史者所占比例较高，为7．1％。HER-2型乳腺癌确诊时肿块较大者所占比例较多，〉5cm者占15．5％；淋巴结阳性者较多，占54．2％；病理分期较晚，Ⅲ期者达34．3％。Luminal型乳腺癌患者年龄偏大，935岁者占91．7％；确诊时病理分期较早，Ⅰ期者占20．4％。中位随访46个月时，Basal-like型、HER-2型和Luminal型乳腺癌患者的复发转移率分别为25．0％、27．9％和11．7％，Basal-like型和HER-2型乳腺癌患者的复发转移率显著高于Luminal型患者（P〈0．001），Basal—like型与HER-2型乳腺癌患者的复发转移率差异无统计学意义，但Basal．1ike型乳腺癌患者肺转移发生率（13．4％）较高（P=0．017）。Basal-1ike型、HER-2型和Luminal型乳腺癌患者的5年无病生存率（DFS）分别为72．2％、68．2％和86．2％（P〈0．001），5年总生存率分别为88．6％、83．8％和95．8％（P〈0．001）。对全部1280例乳腺癌患者的多因素分析结果显示，肿瘤大小、淋巴结状况、激素受体状况、HER-2状况是乳腺癌患者预后的独立影响因素，患者的年龄仅是DFS的影响因素。分别对Basal-like型、HER-2型和Luminal型乳腺癌患者的多因素分析结果显示，肿瘤大小和淋巴结状况是影响各亚型乳腺癌患者预后的2个独立预后因素�Objective To investigate the clinical characteristics and prognosis of patients with different subtypes of breast cancer： basaloid, HER-2 and luminal types, and try to find the evidence of individualized treatment for the patients. Methods 1280 histologically and immunohistochemically proven patients with resectable breast cancer were treated, and the clinical data including characteristics, relapse and survival of the patients with different subtypes of breast cancer were analyzed retrospectively. Results Of the 1280 breast cancer patients, basaloid, HER-2 and luminal types accounted for 20. 9%, 23.2% and 55.9%, respectively. Basaloid type was more likely to be found in younger patients frequently with a family history of breast cancer. HER-2 type usually had a tumor of larger size with more advanced stage disease and more metastatic lymph nodes. Luminal type was hkely to occur in aged patients with an earlier stage disease. The recurrence rates in basaloid, HER-2 and luminal types were 25.0% , 27.9% and 11.7%, respectively. Patients with basaloid or HER-2 type were found to have a significantly higher recurrence rate than the patients with luminal type breast cancer （P 〈0.001 ）, but no significant difference was observed between the basaloid and HER-2 types. However, patients with basaloid type breast cancer were more likely to develop lung metastasis than HER-2 type （ 13.4% vs. 7.1%, P = 0. 017）. Up to December 2006, the 5-year disease-free survival （DFS） rates for patients with basaloid, HER-2 and luminal types were 72.2%. 68.2% and 86.2% （P 〈 0. 001 ）, respectively. The overall 5-yr survival （OS） rates of the three groups were 88.6%, 83.8% and 95.8% （P 〈0.001 ） , respectively. Of the patients with luminal type breast cancer, HER2-negative patients had a higher DFS （86.2% vs 57.0%, P 〈0. 001 ） and OS （95.8% vs 87.7%, P = 0.0001 ） compared with those with HER2-positive. The results of Multivariate Cox Regression showed that tumor size and lymph node state were the most

关 键 词：乳腺肿瘤 分子亚型 预后 

分 类 号：R686[医药卫生—骨科学]