免疫组织化学诊断标准对基底细胞样型乳腺癌预后分析的影响  

Roles of in prognostic assessment of basal-like breast cancer

作　　者：刘慧[1] 范钦和[1] 张智弘[1] 李霄[1] 余慧萍[2] 刘广珍[3] 孟凡青[2] 

机构地区：[1]南京医科大学第一附属医院病理科,210029 [2]南京市鼓楼医院 [3]徐州医学院附属医院

出　　处：《中华病理学杂志》2009年第1期23-28,共6页Chinese Journal of Pathology

基　　金：基金项目：江苏省卫生厅科技发展基金（H200708）

摘　　要：目的探讨不同的免疫组织化学（IHC）诊断标准对基底细胞样型乳腺癌（BLBC）预后分析的影响及意义。方法收集1996-2002年并有5年以上随访资料的浸润性乳腺癌284例，IHC检测ER、PR、HER2、CK5／6、CK14、表皮生长因子受体（EGFR）的表达，按照Nielsen标准[ER^-／HER2^-，CK5／6^＋和（或）EGFR^＋]、Kim标准[ER^-／PR^-／HER2^-，CK5／6^＋和（或）CK24^＋和（或）EGFR^＋]、基底样CK标准[CK5／6^＋和（或）CK14^＋]、三阴性标准[ER^-／PR^-／HER2^-]标准分型并比较其5年生存率。结果在4种标准下，284例浸润性乳腺癌中BLBC的发病率分别为15．5％（44例）、14．8％（42例）、43．3％（123例）、21．1％（60例）；复发率分别为18．2％（8／44）、21．4％（9／42）、10．6％（13／123）、11．7％（7／60），均明显高于其他亚型，但仅在Nielsen和Kim标准中之BLBC型的复发率与其他型差异有统计学意义。Nielsen和三阴性标准中BLBC型之5年无病生存率（均P〈0．01）和5年总生存率（P〈0．05和0．01）显著低于腺腔A型；Kim标准中BLBC型5年无病生存率显著低于腺腔A型（P〈0．01），但5年总生存率与其他分型差异无统计学意义；基底样CK标准的BLBC型与非BLBC型之5年生存率差异无统计学意义。结论在不同的IHC诊断标准下BLBC均呈高复发和预后差的趋势，但不同的分型标准影响其预后分析结果，相对完善、统一的诊断标准是亟待解决的问题。Objectives Basal cell-like breast cancer is one of the subtypes using molecular typing, and this subtype attracted a wide spread attention. Currently, no uniform diagnostic criteria are available. Most studies demonstrated poor outcomes, but contradictory conclusions appeared recently. The prognosis of basal cell-like breast cancer using different immunohistochemical criteria were analysed. Methods Two hundred and eighty-four invasive breast cancers with a follow-up information over 5 years were evaluated for ER, PR, HER2, CK5/6, CK14, EGFR expression on tissue microarray immunohistochemically. Based on the results, these cases using four different diagnostic criteria were categorized, namely： Nielsen （ER-/HER2-, CK5/6＋ and/or EGFR＋）, Kim （ER-/PR-/HER2-, CK5/6＋ and/or CK14＋ and/or EGFR＋）, Triple-negative （ER-/PR-/HER2-）, and basal-CK （CK5/6＋ and/or CK14＋）. 5-year survival information was compared between groups. Results The prevalence of basal cell-like breast cancer by Nielsen, Kim, Triple-negative and basal-CK were 15.5% （ 54/284 ）, 14. 8% （ 42/284 ）, 43. 3% （123/284） and 21.1% （60/284） respectively; the recurrence rates were 18. 2% （8/44）, 21.4% （9/42）, 10.6% （13/123） and 11.7% （7/60） respectively. These were higher than recurrence rates for other subtypes, but only the differences by Nielsen＇s and Kim＇s criteria were significant. Using Nielsen＇s and Triple-negative＇s criteria, basal-like tumors showed shorter 5-year disease-free survival （ both P 〈 0. 01 ） and overall survival （ P 〈 0. 05 and 0. 01 ） than luminal A subtype, using Kim＇ s criteria, basal-like tumors showed a lower 5-year disease-free but not overall survival than luminal A subtype （ P 〈 0. 01 ） ; no significant difference was found on 5-year survival between basal-like and non-basal-like tumors when typed by basal-CK. Conclusion Basal cell-like breast cancers are more likely to show more recurrence and worse outcome, but different immunohistochemical dia

关 键 词：乳腺肿瘤 癌 基底细胞 免疫表型分型 参考标准 诊断 预后 

分 类 号：R686[医药卫生—骨科学]