176例HER2阳性乳腺癌首发转移部位的分析  

The primary metastatic sites in 176 patients with HER2 positive breast cancer

作　　者：李惠平[1] 冉然[1] 李鹍[1] 孔维垚 刘笑然[1] 王晶[1] 张如艳[1] 邵彬[1] 严颖[1] 姜晗昉 刘雅昕[1] 张嘉杨 LI Hui-ping RAN Ran LI Kun KONG Wei-yao LIU Xiao-ran WANG Jing ZHANG Ru-yan SHAO Bin YAN Ying JIANG Han-fang LIU Ya-xin ZHANG Jia-yang(Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）, Department of Breast Ontology, Peking University Cancer Hospital and Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺肿瘤内科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《癌症进展》2016年第12期1167-1169,1190,共4页Oncology Progress

摘　　要：目的分析176例HER2阳性乳腺癌患者首发转移部位与分子类型的关系,帮助判断HER2阳性乳腺癌治疗和随访策略。方法回顾性分析176例HER2阳性复发转移乳腺癌患者的临床资料,HER2阳性定义为免疫组化＋＋＋,或FISH扩增,病理为浸润性导管癌,分析术后首次复发转移的分布情况。结果 176例患者中,中位年龄50岁（范围31-76岁）;首发肝转移占38.1%,其中单发肝转移占18.8%;肺转移29.0%,其中单发肺转移11.4%;肝和肺转移之间差异有统计学意义（P=0.045）;淋巴结转移42.6%（包括锁骨上下淋巴结、腹腔淋巴结、纵隔淋巴结等）,其中单发淋巴结转移19.9%;骨转移25.1%,其中单发骨转移6.3%;胸壁复发14.3%,包括仅胸壁复发的8.0%;含脑转移的4例（2.3%）;还有一些少见部位转移：卵巢转移1例,子宫转移1例。首发内脏转移占59.7%,首发即多部位转移的占34.7%。结论 HER2阳性乳腺癌转移有其特殊性,内脏和淋巴结转移多见,内脏转移中肝转移更常见。所以在辅助治疗后的随访中,除了要关注淋巴结的状况外,还要关注内脏的检查,尤其是肝和肺。同时也间接地说明不同的分子类型转移的方式是不同的,所以术后辅助化疗也应该考虑器官转移的特殊性,采取相对应的药物。Objective To analyze the association between the primary metastatic sites of HER2-positive breast cancer and the molecular subtypes, and to establish the treatment and follow up strategy for HER2-positive breast cancer. Meth Method The clinical data of 176 patients with HER2-positive metastatic breast cancer were analyzed. HER2-positive was defined as（＋＋＋） in immunohistochemistry or FISH amplification, and was pathologically classified as invasive ductal carcinoma, and then the distribution of primary recurrence and metastasis in those patients were analyzed. Result The median age was 50（range： 31-76） in the 176 patients; and primary liver metastasis was observed in 38.1%, including 18.8% of single liver metastasis; 29.0% of patients had lung metastasis, with 11.4% of single lung metastasis; and a significant difference was observed between liver and lung metastasis（P=0.045）; there were 42.6% of patients had lymph node metastasis（including supraclavicular, abdominal and mediastinal lymph nodes, etc.）, in which 19.9% had single lymph node involvement; 25.1% had bone metastasis, including 6.3% of single bone; chest wall recurrence rate was 14.3%, and 8.0%had sole chest wall involvement; 4 cases（2.3%） were with brain metastases; other rare metastases includes： ovarian（1case） and uterine metastasis（1 case）. Primary visceral metastasis rate was 59.7%, while 34.7% of patients had multiple sites involvement. Conclusion The metastasis of HER2- positive breast cancer is unusual in nature, with more visceral and lymph nodes metastasis, especially in liver. In the follow-up setting after surgery and adjuvant therapy, more attention should be paid to lymph nodes and visceral examination, especially for liver and lung. Meanwhile, the results also indirectly explain the different metastasis pattern of various molecular subtypes, so corresponding medications are required in postoperative adjuvant chemotherapy when metastatic sites are considered.

关 键 词：转移部位分布 进展期乳腺癌 HER2阳性 

分 类 号：R737.9[医药卫生—肿瘤]