乳腺癌首发肺转移38例临床病理特征及预后因素  

Clinicopathological features and prognostic factor analysis for 38 breast cancer patients with first-episode lung metastasis

作　　者：张和军[1] 沈武成 朱伟峰[1] 陈刚[1] 吴秀凤[2] 夏言 许春伟[1] 崔兆磊[3] 胡丹[1] ZHANG Hejun;SHEN Wucheng;ZHU Weifeng;CHEN Gang;WU Xiufeng;XIA Yan;XU Chunwei;CUI Zhaolei;HU Dan(Department of Pathology;Department of Breast Surgery;Department of Clinical Laboratory,Fujian Medical University Cancer Hospital ＆ Fujian Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建医科大学附属肿瘤医院福建省肿瘤医院病理科,福州350014 [2]福建医科大学附属肿瘤医院福建省肿瘤医院乳腺外科,福州350014 [3]福建医科大学附属肿瘤医院福建省肿瘤医院检验科,福州350014

出　　处：《临床与病理杂志》2018年第10期2082-2087,共6页Journal of Clinical and Pathological Research

基　　金：福建省自然科学基金(2016J01508;2018J01264);福建省卫生厅中青年骨干人才培养项目(2016-ZQN-17);福建省医学创新课题(2017-CXB-2)~~

摘　　要：目的:比较乳腺癌原发灶与首发肺转移灶的临床病理特征,探讨乳腺癌首发肺转移病例的临床病理特点与预后的关系。方法:收集38例乳腺癌首发肺转移的病例临床资料及预后,采用免疫组织化学检测雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2),Ki-67,甲状腺转录因子-1(thyroid transcription factor-1,TTF-1),GATA3在肺转移灶的表达。结果:38例首发肺转移乳腺癌病理类型浸润性导管癌37例,黏液癌1例。组织学分级I级4例,II级28例,III级6例;分子分型luminalA型患者21例,luminal B型患者7例,HER-2过表达型3例,三阴性乳腺癌(triple-negativebreastcancer,TNBC)7例。TNM分期:I期10例,II期14例,III期13例,IV期1例。肺转移灶各组免疫组织化学指标阳性例数为ER 26,PR22,HER-26,TTF-10,GATA337,转移灶的组织学分级和Ki-67指数均高于原发灶(P<0.05)。Kaplan-Meier生存曲线显示HER2过表达与TNBC3年和5年无病生存期低于luminal型(P<0.05)。结论:乳腺癌首发肺转移患者转移灶与原发灶病理类型相同,但组织学分级和Ki-67指数高于原发灶,分子分型可发生改变。与luminal型患者比较,HER2过表达与TNBC患者3年和5年无病生存期更短。联合检测GATA3,TTF-1,ER,PR,HER-2表达有助于乳腺癌肺转移的鉴别诊断。Objective： To compare the clinicopathological features of primary tumors and the lung metastatic tumors, and analyze the relationship between clinicopathological features and prognosis in patients with first-episode lung metastasis of breast cancer. Methods： Thirty-eight breast cancer patients with first-episode lung metastasis were identified. Immunohistochemical staining for estrogen receptor（ER）, progesterone receptor（PR）, human epidermal growth factor receptor 2（HER2）, Ki-67, thyroid transcription factor-1（TTF-1）, GATA-3 were performed on the primary tumors and the lung metastatic tumors. Results： Thirty-seven of the 38 primary tumors were invasive ductal carcinoma, one was mucinous carcinoma. Carcinomas of nuclear Grade 3 were more frequent than those of Grade 1 or 2. Patients with Luminal A were more than those of Luminal B, HER2-overexpression and triple-negative breast cancer（TNBC）. Twenty-six cases of ER, 22 PR, 6 HER2, 0 TTF-1, and 37 GATA-3 were found in the metastatic foci of lung. The histologic grade and Ki-67 index in metastatic tumor were higher than those in primary foci. In the patients with HER2 overexpression and TNBC, the disease-free survival（DFS） with lung metastasis was shorter than those with luminal subtypes. Conclusion： Metastatic tumors were similar to those of primary lesions in histological types, but their histological grade and Ki-67 index were higher than primary tumors. Compared with patients with luminal subtypes, HER2 overexpression and TNBC subtypes tend to associate with lung metastasis at the early stage. Detection of GATA-3 combined with TTF-1, ER, PR, and HER2 could be used in distinguishing the lung metastasis of breast cancer.

关 键 词：乳腺癌 肺转移 预后 分子分型 

分 类 号：R737.9[医药卫生—肿瘤]