乳腺癌局部区域复发病灶受体状态检测及对后续治疗的指导价值  

Receptor status testing and its influence on following treatment selection in breast cancer patients with loco-regional recurrence

作　　者：陆裕杰 金泽宇 李亚芬[1] 沈坤炜[1] 陈伟国[1] 陈小松[1] LU Yu-jie;JIN Ze-yu;LI Ya-fen;SHEN Kun-wei;CHEN Wei-guo;CHEN Xiao-song(Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)

机构地区：[1]上海交通大学医学院附属瑞金医院乳腺疾病诊治中心

出　　处：《上海交通大学学报（医学版）》2019年第9期1071-1076,1071,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市教育委员会高峰高原学科建设计划（20172007）;上海交通大学医学院附属瑞金医院“广慈卓越青年培养计划”(GCQN-2017-A18)~~

摘　　要：目的·分析局部区域复发(loco-regional recurrence,LRR)乳腺癌患者原发灶和LRR 病灶雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor,PR)、人类表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)和增殖细胞核抗原Ki67 状态的符合率及对后续治疗的影响。方法·回顾性分析2009 年1 月-2018 年9 月,在上海交通大学医学院附属瑞金医院乳腺疾病诊治中心接受乳腺癌手术治疗,随访发生单纯LRR 的乳腺癌患者。对原发灶和LRR 病灶进行ER、PR、HER-2 和 Ki67 状态检测,分析两者之间的一致性及后续治疗的选择。结果·在7 823 例接受手术乳腺癌患者中,有106 例发生单纯LRR,其中 56 例患者LRR 病灶检测了ER、PR、HER-2 和Ki67 状态,其阳性率分别为48.2%、25.0%、35.2%和81.5%,与原发灶的符合率分别为76.8%、76.8%、89.1%和77.8%,κ值分别为0.538、0.469、0.729 和0.402。共有18 例患者激素受体(ER 或PR)(14 例)和/或 HER-2(6 例)状态发生改变:9 例激素受体状态由阳性变为阴性,其中4 例未接受后续内分泌治疗;4 例患者HER-2 状态由阴性变为阳性,其中1 例接受后续抗HER-2 靶向治疗。结论·乳腺癌原发灶与LRR 病灶的ER、PR 和Ki67 存在中度一致性,而HER-2 的一致性较高;LRR 病灶受体状态的改变会影响其后续治疗方案的选择。Objective · To analyze the concordance rates of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), and Ki67 statuses between the primary and loco-regional recurrence (LRR) lesions and its influence on the following treatment in breast cancer patients. Methods · The breast cancer patients undergoing surgery in Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2009 to September 2018, who were reported recurrence only in loco-regional site were retrospectively analyzed. ER, PR, HER-2, and Ki67 statuses were detected in primary and LRR lesions. Concordance rates and their influence on following treatment were further analyzed. Results · A total of 7 823 breast cancer patients received surgery, among whom 106 cases experienced LRR without distant metastasis. There were 56 patients having full information about ER, PR, HER-2, and Ki67 statuses of LRR lesions, with the positive rates of 48.2%, 25.0%, 35.2%, and 81.5%, respectively. Concordance rates of ER, PR, HER-2, and Ki67 between primary and LRR lesions were 76.8%, 76.8%, 89.1% and 77.8%, with κ values at 0.538, 0.469, 0.729, and 0.402, respectively. Hormone receptor (ER or PR)(14 cases) and/or HER-2 (6 cases) statuses were altered in 18 patients. The hormone receptor status changed from positive to negative in 9 cases, of which 4 cases did not receive following endocrine therapy. The HER-2 status changed from negative to positive in 4 patients, and 1 of them received following anti-HER-2 targeted therapy. Conclusion · The concordance rates between primary and LRR breast cancer lesions of ER, PR, and Ki67 are moderate, and the concordance rate of HER-2 is high. Changes in receptor status in LRR lesions may affect the choice of following treatment options.

关 键 词：乳腺癌 局部区域复发 雌激素受体 孕激素受体 人类表皮生长因子受体-2 一致性分析 治疗 

分 类 号：R737.9[医药卫生—肿瘤]