乳腺癌原发肿瘤与局部复发肿瘤组织中受体表达的差异及其临床意义  

Differences and clinical significance of receptor expression between primary and locally recurrentbreast tumor tissues

作　　者：马祥敏[1] 韩芸蔚[1] 张矫[1] 崔文静[1] 王欣[1] 

机构地区：[1]天津医科大学附属肿瘤医院乳腺肿瘤一科、乳腺癌防治教育部重点实验室、天津市肿瘤防治重点实验室,300060

出　　处：《中华肿瘤杂志》2013年第5期372-376,共5页Chinese Journal of Oncology

摘　　要：目的探讨乳腺癌患者原发肿瘤和局部复发肿瘤组织中受体表达的差异及其对生存的影响。方法采用免疫组织化学和荧光原位杂交法检测70例乳腺癌患者的原发肿瘤和局部复发肿瘤组织中雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER-2）的表达情况，分析其表达差异对乳腺癌患者总生存时间（OS）和复发后生存时间（PRS）的影响。结果乳腺癌原发肿瘤和局部复发肿瘤组织中ER表达有效变化率为26．1％（18／69），PR表达有效变化率为50．0％（34／68），HER-2表达有效变化率为10．3％（4／39）。60例随访患者中，死亡23例（38．3％），中位生存时间为107个月（11～288个月）；3年生存率为84．3％，5年生存率为71．6％，10年生存率为45．7％。Kaplan-Meier方法分析结果显示，ER表达改变可影响乳腺癌患者的0S（P=0．001）和PRS（P〈0．001），PR表达改变不影响乳腺癌患者的OS（P：0．416）和PRS（P=0．056），但不论原发肿瘤的PR状态如何，局部复发肿瘤PR阳性患者的0s和PRS明显好于PR阴性患者。HER-2表达改变不影响乳腺癌患者的OS（P=0．840）和PRS（P=0．544）。结论乳腺癌原发肿瘤和局部复发肿瘤组织中ER、PR和HER-2的表达存在差异，对患者生存有明显的影响。重新检测复发肿瘤组织中的ER、PR和HER-2表达情况，对指导治疗和评估预后有一定意义。Objective To compare the difference of receptor expression between primary and locally recurrent breast tumor tissues, and analyze their impact on survival of the patients. Methods The expression of estrogen receptor （ER）, progesterone receptor （PR） and human epidermal growth factor receptor-2 （HER-2） of primary and locally recurrent breast tumor tissues of 70 breast cancer patients were analyzed by immunohistochemistry or fluorescence in situ hybridization. The impact of the differences on overall survival （OS） and post-recurrence survival （PRS） of the patients was analyzed. Results The effective discrepancy rates between primary and locally recurrent breast cancer tissues were 26.1% （18/69） for ER, 50.0% （34/68） for PR, and 10.3% （4/39） for HER-2 expressions. In the 60 cases who had complete follow-up data, 23 patients （38.3%） died and the median overall survival was 107 months （ 11- 288 months ）. The 3-, 5- and 10-year overall survival rates were 84. 3% , 71. 6% and 45. 7% , respectively. Kaplan-Meier survival analysis showed that the changes of ER expression had significant impact on the OS （P =0.001） and PRS （P 〈0.001）, but PR had no significant effect on OS （P =0.416） and PRS （P = 0.056）. However, the OS and PRS for patients with PR ~ locally recurrent tumors were better than that of PR- patients regardless of the primary tumor PR status. The expression of HER-2 had no significant effect on the OS （ P = 0. 840） and PRS （ P = 0. 544） of the patients. Conclusions An expression discrepancy of ER, PR and HER-2 exists between primary and locally recurrent breast cancer tissues, it significantly affects the survival of the patients. Re-evaluation of the expressions of ER, PR and HER-2 receptor in locally recurrent breast tumor tissue is beneficial for their therapy and prognosis.

关 键 词：乳腺肿瘤 受体 雌激素 受体 孕激素 人表皮生长因子受体2 治疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]