乳腺癌分子分型的临床意义  

Clinical significance of four subtypes of breast cancer

作　　者：曹华[1,2] 闫茂生[1,3] 郑涛[1,2] 许瑞莲[1,2] 陈亦欣[1,2] 王树滨[1,2] 刘雅洁[1,3] 

机构地区：[1]暨南大学第二临床医学院 [2]深圳市人民医院肿瘤内科,深圳518020 [3]深圳市人民医院肿瘤放射治疗科,深圳518020

出　　处：《中华乳腺病杂志（电子版）》2011年第6期15-21,共7页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：深圳市科技计划项目(201003001)

摘　　要：目的利用乳腺癌的3种分子标志物的检测结果将乳腺癌简易分为4种分子亚型,并探讨这4种分子亚型的临床特征及影响预后的因素。方法依据雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子受体2(HER-2)的免疫组织化学检测结果,采用回顾性方法将本院510例乳腺癌患者分为luminal A、luminal B、HER-2(+)及basal-like4种类型。对各型的临床特征采用SPSS13.0统计软件进行分析,并用Kaplan-Meier法和Cox回归分析各型患者的生存情况及预后因素。结果在510例乳腺癌患者中,luminal A型、luminal B型、HER-2(+)型及basal-like型分别占56.86%(290/510)、9.02%(46/510)、3.53%(18/510)和30.59%(156/510)。中位随访66个月,luminalA型、luminal B型、HER-2(+)型及basal-like型患者的5年总生存率分别为96.21%(279/290)、97.83%(45/46)、83.33%(15/18)和78.85%(123/156),5年无瘤生存率分别为88.62%(257/290)、95.65%(44/46)、83.33%(15/18)和72.44%(113/156)。basal-like型与luminalA、luminal B型相比,患者无瘤生存率及总生存率较低(P<0.05);HER-2(+)型患者的总生存率比luminalA型患者低(P<0.05)。经Cox多因素预后分析发现淋巴结状况及分子分型是影响乳腺癌预后的重要因素,淋巴结阳性患者的预后较淋巴结阴性患者差,luminal A型、luminal B型、HER-2(+)型及basal-like型患者的预后依次变差(P=0.00)。结论不同分子亚型的乳腺癌患者表现不同的临床特征及预后。淋巴结状况及分子类型是影响乳腺癌患者预后的重要因素,淋巴结阳性及basal-like型患者预后最差。Objective To study the clinical characteristics, and the prognostic factors of four subtypes in breast cancer classified by three molecular marker levels. Methods Based on immunohistochemical results of estrogen receptor （ER）, progesterone receptor （PR）, and HER-2, totally 510 breast cancer patients were divided into four different subtypes： luminal A, luminal B, HER-2 （＋）and basal-like. Their clinical characteristics were retrospectively reviewed by SPSS13.0 software. The survival rate and prognosis were also analyzed by Kaplan-Meier method and Cox regression. Results Among the 510 breast cancer patients, 56. 86% （290/510） of patients were of luminal A subtype, 9.02% （46/510） luminal B, 3.53% （18/510） HER-2（ ＋）, and 30.59% （156/510） basal-like subtype. The median time of follow-up was 66 months. The 5-year overall survivals of luminal A, luminal B, HER-2（＋） and basal-like subtype were 96.21% （279/290）, 97.83% （45/46）, 83.33% （15/18）and 78.85% （123/156）, and the 5-year disease-free survivals of those were 88.62% （257/290）, 95.65% （44/46）, 83.33% （15/18） and 72.44% （113/156）. The disease-free survival and overall survival in basal-like subtype were lower than those in luminal A or in luminal B subtype （P〈0.05）. The overall survival in HER-2 （＋）subtype was lower than that in luminal A subtype （P〈0.05）. According to the result of the Cox multiple-factor analysis, the lymph node status and molecular subtype were important factors for the prognosis of breast cancer patients. The prognosis of the patients with lymph node metastasis was worse than that of the patients without lymph node metastasis. Favourable prognosis of the four subtypes were as follows： luminal A〉luminal B〉HER-2（＋） 〉basal-like （P=0.00）. Conclusion Breast cancer patients in different subtypes have different clinical characteristics and prognosis. The lymph node status and molecular subtype are the important prognostic factors. The patients w

关 键 词：乳腺肿瘤 分子亚型 临床特征 预后 

分 类 号：R737.9[医药卫生—肿瘤]