浸润性乳腺癌近似分子亚型的临床意义  

Clinical Significance of Approximated Molecular Subtypes of Invasive Breast Cancer

作　　者：耿其荣[1] 刘冬耕[1] 史艳侠[1] 向锦[2] 吕跃[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,广东广州510060 [2]华南肿瘤学国家重点实验室∥中山大学肿瘤防治中心病理科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2009年第4期458-462,467,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨浸润性乳腺癌近似分子亚型的临床意义。【方法】回顾性分析浸润性乳腺癌患者,依据免疫组化雌激素受体(ER)、孕激素受体(PR)、HER2水平将其近似划分为Luminal A(ER+和/或PR+,HER2-)、LuminalB(ER+和/或PR+,HER2+)、HER2+(EP-,PR-,HER2+)和Basal-like(EP-,PR-,HER2-)4个分子亚型,各362、107、86和148例,对比分析该4型患者的分布比例、发病年龄、绝经状态、病理组织学类型、病理分级、肿瘤大小、淋巴结状态等临床特征及首次复发时间和部位的特点。【结果】所有703例患者中,Luminal A型比例最高,占51.5%;Luminal B和HER2+型所占比例最少。整体人群发病年轻,90.8%的患者在59岁以下。其中40岁以下患者Luminal A型最多。不同分子亚型病理分级构成差异显著,Luminal A型中,组织学1级患者比例最高,并且T1期肿瘤比例明显高于其他各亚型,HER2+型则以T4期肿瘤最多。各亚型间淋巴结分布无明显差异,仅在LuminalB和HER2+型出现N3高比例分布趋势。复发转移患者中,Luminal A型首次复发时间最长,HER2+型最短,且HER2+和Basal-like型肺转移率高。与国外报道不同,本研究未显示出各亚型中局部复发与远处转移的分布差异。【结论】蛋白标记近似分子分型简单明了,切实可行。国人乳腺癌具有蛋白标记近似的不同分子亚型,与国外大体相似,Luminal A型临床特征相对较好,HER2+型与Basal-like型具有较高的肺转移率。但仍有不同之处,尤其是Luminal A型年龄分布呈现年轻化。[Objective] To investigate the clinical significance of approximated molecular subtype. [Methods] Four different subtypes were defined by immunohistochemical （IHC） markers as estrogen receptor （ER）, progesterone receptor （PR） and HER2. Clinical characteristics as distribution, age, menopausal status, histopathologic type and grading, tumor size, lymph node status, time to and place of first tumor recurrence were analyzed. [Results] Among all 703 cases, Luminal A was the majority （51.5%） and the least were Luminal B and HER2＋. 90.8% the patients were less than 59 years old with Luminal A. Different subtype has different histopathologic grading. Luminal A was more than others among grading 1 tumors and it has more T1 tumors, while T4 tumors was most among HER2＋ ones. Lymph nodes metastasis has no significant difference between different groups, other than high proportion tendency of N3 stage in Luminal B and HER2＋. In addition, Luminal A has the longest time to the first recurrence while HER2＋ was the shortest. Moreover, HER2＋ and Basal-like have high rates of lung metastasis. Different from foreign reports, the distribution of the first recurrent place and distant metastases have no significant difference. [Conclusion] The classification of breast cancer approximated molecular subtype defined by IHC markers was feasible. The distribution is similar to other countries. Luminal A has rather better clinical characteristics while HER2＋ and Basal-like have high rates of lung metastasis. However, Luminal A has the highest proportion of young patients, which is different from other countries.

关 键 词：乳腺癌 分子分型 临床特征 

分 类 号：R737.9[医药卫生—肿瘤]