基底细胞样型乳腺癌的临床病理特点和预后意义  

Clinicopathologic features and prognostic significance of basal-like breast cancer

作　　者：刘慧[1] 范钦和[1] 李霄[1] 刘广珍[2] 

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

出　　处：《中华病理学杂志》2009年第5期316-322,共7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：目的探讨中国乳腺癌人群中基底细胞样型乳腺癌（BLBC）的流行病学、临床病理特征和预后意义。方法采用组织芯片、免疫组织化学和形态学分析等方法将1311例浸润性乳腺癌组织标本分为腺腔A型、腺腔B型、BLBC型、HER2型和不表达型，并分析BLBC的流行病学、临床病理特点。获得随访资料523例，随访2～132个月，平均65．8个月。结果BLBC发病率17．0％（223／1311），HER2型和不表达型的发病年龄均显著低于腺腔A型，肿瘤直径显著高于腺腔A型。组织结构上，BLBC多为组织学3级，较HER2型和腺腔A型更多见瘤细胞弥漫片状分布和带状分布于坏死周围的特点；多见大块地图状坏死和中央瘢痕、推进性边缘、肿瘤内淋巴细胞浸润和高核分裂指数；细胞形态上，合体细胞和基底样细胞、鳞状细胞化生和梭形细胞化生多见于BLBC。BLBC的复发率显著高于腺腔A型和HER2型，淋巴结转移率显著低于HER2型和不表达型；其他ER阴性乳腺癌（HER2型、不表达型）之无病生存率和总生存率均显著低于腺腔A型；Cox多因素风险模型分析显示基底细胞样标记不是乳腺癌独立预后因素。结论BLBC在中国乳腺癌人群中的发病率与大多数国外文献报道相似。该亚型乳腺癌既具有不同于非BLBC的、独特的临床病理特点，也具有与其他ER阴性乳腺癌相同的临床病理特点；其形态学上的诸多特征虽不十分特异，但可作为诊断线索提示病理医师结合免疫组织化学等检查做出正确诊断。与腺腔A型相比，BLBC与其他ER阴性乳腺癌具有较差的预后。Objective To analyzed a large group of invasive breast cancers with long-term follow-up information to evaluate the clinicopathologic, morphological and prognostic features of basal-like breast cancers in Chinese population. Methods Immunohistochemistry was used to detect the expression of ER, HER2,CK5/6,EGFR on tissue microarray with 1311 invasive breast cancers. Based on the results, these cases were categorized into luminal A, luminal B, basal-like, HER2-overexpressing and null subtypes. Clinicopathological features and survival rates were compared between these groups. Results Basal-like breast cancers constituted 17. 0% of 1311 invasive breast cancers with a significantly larger size, higher grade and higher incidence of the medullary carcinoma, frequent recurrence and infrequent node metastasis. Morphologically, basal-like breast cancers showed a significantly more solid architecture and ribbon-like architecture associated with necrosis （more geographic necrosis） and central scar, a more pushing margin, lymphocytic infiltration and a higher mitosis score, more syncytial growth, presence of basaloid ceils, spindle cells and squamous metaplasia. The disease-free survival and overall survival of basal-like breast cancers were significantly poorer than that of luminal A subtype, but similar to the other ER-negative subtypes. Basal markers were not independent prognostic factors. Conclusions Basal-like breast cancers in Chinese population has a similar prevalence to that of the western populations. They have distinct clinicopathologic features compared to other non-basal breast cancers, but overlapping with other ER-negative breast cancers. Morphological features are strongly associated with basal-like breast cancers although they are not very specific. The survival of basal-like breast cancers is poorer than luminal A, but similar to the other ER-negative breast cancers, and basal markers are not independent prognostic factors of breast cancers.

关 键 词：乳腺肿瘤 免疫表型分型 癌 基底细胞样 诊断 鉴别 预后 

分 类 号：R686[医药卫生—骨科学]