乳腺癌进展后相关受体转化及影响因素研究  

The conversion of relevant receptors in advanced breast cancer and related influencing factors

作　　者：崔志超[1] 李泽源 王雅琪[1] 马杰[1] 谷峥[1] 周立芝[1] 陈晶晶[1] CUI Zhichao;LI Zeyuan;WANG Yaqi(Department of Breast Cancer Surgery,Tangshan People’s Hospital,Hebei,Tangshan 063000,China;不详)

机构地区：[1]河北省唐山市人民医院乳腺外科,063000 [2]哈尔滨医科大学

出　　处：《河北医药》2020年第16期2451-2454,2458,共5页Hebei Medical Journal

摘　　要：目的探讨原发性乳腺癌与转移性乳腺癌(metastatic breast cancer,MBC)组织中雌激素受体(estrogen receptor,ER),孕激素受体(progesterone receptor,PR)及人类表皮生长因子受体2(human epidermalgrowth factor receptor-2,HER2)在个体内的相关状况。次要目标包括患者的特点及与受体状态不一致,相关的预测因素。方法研究对象的原发灶及其复发转移灶均经病理学验证。回顾性研究患者的人口统计资料、肿瘤特征、治疗特点与ER、PR和HER2状态。免疫组化法检测受体状态,阳性指标为ER阳性率≥1%,PR阳性率≥1%,HER2免疫组化评分为3+或荧光原位杂交扩增率为>2时,被认为是阳性的。结果共有147例乳腺癌原发灶转移复发的组织病理学样本。原发性乳腺癌和MBC之间的一个或多个受体不一致65例(44.22%)。在21.77%的肿瘤中发现ER受体的不一致性(P<0.01),在23.13%的肿瘤中发现PR受体的不一致性(P<0.01),在13.61%的肿瘤中发现HER2受体的不一致性(P<0.01)。以他莫昔芬为基础的内分泌治疗与PR受体的表达状态密切相关,抗HER2治疗与HER2受体的表达的不一致性相关。结论乳腺癌原发肿瘤和相应的转移灶之间的ER、PR、HER2表达的不一致性高,影响因素较多;受体的表达差异及不同的治疗策略对患者的预后有影响,关于既往治疗对乳腺癌相关受体转化有无影响及其分子机制仍值得进一步研究。Objective To investigate the expressions of estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER2)between primary breast cancer and metastatic breast cancer(MBC),and to explore the patients’characteristics,overall survival rate and related predictive factors.Methods The primary focus and metastasis focus of all the patients were identified by pathological examination.The data including demographics,tumor characteristics,treatment characteristics,ER,PR,and HER2 statuses were retrospectively analyzed,and the receptor levels were detected by immunohistochemistry,with a positive standard of the positive rate of ER and PR being≥1%,and that of HER2 being 3+in immunohistochemistry or amplification ratio being>2 in fluorescent in situ hybridization.Results Among the 147 specimens of breast cancer primary focus metastasis and relapse,there were 65 cases(44.22%)with the discordance in one or more receptors between primary breast cancer and MBC,that of ER was found in 21.77%of cancers(P<0.01),and that of PR was observed in 23.13%of cancers(P<0.01),and that of HER2 was found in 13.61%of cancers(P<0.01).Tamoxifen based on endocrine therapy was closely correlated with the expression levels of PR,moreover,the anti HER2 therapy was associated with the unconsistency of expression of HER2.Conclusion The expression levels of ER,PR and HER2 are different between primary tumors and metastases,which are influenced by many factors,and the receptor expression differences and different treatment strategies have an impact on the prognosis of patients.Whether the previous treatment has any effect on breast cancer related receptor transformation,and its molecular mechanism is worthy of further study.

关 键 词：乳腺癌 肿瘤异质性 病理学评估 总体生存率 

分 类 号：R737.9[医药卫生—肿瘤]