分子分型在老年乳腺癌患者中的临床意义探讨  

Clinical significance of molecular subtypes of breast cancer in patients aged over 60 years

作　　者：华彬[1] 肖文政[1] 王征[2] 张伟[2] 陆旭[1] 李波[1] 

机构地区：[1]北京医院乳腺中心,100730 [2]北京医院病理科,100730

出　　处：《中华老年医学杂志》2016年第4期371-375,共5页Chinese Journal of Geriatrics

基　　金：国家科技支撑计划（2014BA108803）

摘　　要：目的回顾性分析60岁以上乳腺癌患者分子分型的分布比例，探讨其对60岁以上乳腺癌患者的预后及个体化治疗的指导意义。方法回顾性分析2009年1月至2014年6月北京医院乳腺中心所有60岁以上的浸润性乳腺癌患者，根据2013年St，Gallen会议专家共识的诊断标准将所有浸润性乳腺癌进行分子分型；患者术后每半年随访1次，随访截止至2014年12月。分析不同分子亚型乳腺癌的临床病理特点，预后指标。结果共770例患者满足研究要求，其中I。uminalA型224例（29．1％），LuminalB型366例（47．5％），Her2过表达型50例（6．5％），三阴性乳腺癌130例（16．9％）。与LuminalA型乳腺癌相比其他各型乳腺癌具有肿瘤更大、淋巴结转移更多、TNM分期更晚的特点（均P〈0．01）。根据随访结果进行单因素分析和多因素分析，提示年龄超过80岁以及分子亚型是乳腺癌独立的预后因素（均P％0．05）。LuminalA型乳腺癌预后相对较好，三阴性乳腺癌的预后相对最差。结论老年乳腺癌患者中，分子分型具有良好的预后指示作用，可以考虑作为60岁以上乳腺癌患者个体化治疗的参考指标；临床工作中应该结合乳腺癌分子分型为80岁以上的老年人提供合理的治疗。Objective To retrospectively analyze the distribution percentage points of molecular subtypes of breast cancer and investigate its guiding significance in the prognosis and personalized therapy in patients with breast cancer aged over 60 years. Methods A retrospective analysis of all patients with invasive breast cancer aged over 60 years from January 2009 to June 2014 in Breast Center of Beijing Hospital was performed. Based on the immunohistochemical methods recommended in the St. Gallen International Expert Consensus Report 2013 ,the molecular subtypes of breast cancer in these patients were identified. All patients were followed up every 6 months after operation until December 2014. Clinical pathological characteristics and prognosis indexes in different molecular subtypes of breast cancer were evaluated. Results Totally 770 patients aged over 60 years with invasive breast cancer met the criterion. The luminal A, luminal B, human epidermal growth factor receptor 2 （HER2） over-expression, triple- negative subtypes accounted for 29.1 % （ 224 cases）, 47.5 （366 cases） ,6.5% （50 cases）and 16.9% （130 eases）of patients,respectively. The luminal A subtype of breast cancer had larger tumor size, more lymph node metastasis and more late TNM stage as compared with other subtypes（all P〈0.01）. Univariate and multivariate analysis showed that aged 80 years and the triplenegative molecular subtype were the independent poor prognostic factors for breast cancer（both P〈0.05）. The luminal A subtype of breast cancer had relatively good prognosis, while the triplenegative subtype had relatively poor prognosis. Conclusions Molecular subtypes have a significant prognostic effect on breast cancer in patients aged over 60 years, which suggests molecular subtype can be considered as a reference indicator in personalized therapy. Patients aged over 80 years has poor prognosis due to less rational treatment. The reasonable and target treatment based on the molecular subtype of breast cancer should be p

关 键 词：乳腺肿瘤 分子分型 预后 

分 类 号：R737.9[医药卫生—肿瘤]