人表皮生长因子受体2低表达乳腺癌的临床病理学特征及预后  

Clinicopathological features and prognosis of breast cancer with human epidermal growth factor receptor 2 low expression

作　　者：朱晓娟 张虹[1] 张爽[1] 李东[1] 李鑫[1] 徐玲[2] 李挺[1] ZHU Xiao-juan;ZHANG Hong;ZHANG Shuang;LI Dong;LI Xin;XU Ling;LI Ting(Department of Pathology,2.Breast Disease Center,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院病理科,北京100034 [2]北京大学第一医院乳腺疾病中心,北京100034

出　　处：《北京大学学报（医学版）》2023年第2期243-253,共11页Journal of Peking University:Health Sciences

摘　　要：目的:新型抗人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)抗体偶联药物临床试验的成功,使HER2低表达乳腺癌是否将成为新的乳腺癌类型而受到关注。本研究分析比较HER2低表达与HER2零表达两组乳腺癌患者间的临床病理特征及生存数据,探讨其临床生物学上的差异性。方法:2014年1月至2017年12月北京大学第一医院乳腺疾病中心收治的1250例女性原发性非转移性乳腺癌中,969例HER2阴性(免疫组织化学染色评分为0、1+、2+,且荧光原位杂交未扩增),分析其中HER2低表达(1+或2+且荧光原位杂交未扩增)和HER2零表达(0分)两组患者间临床病理特征及预后情况。对两组患者进行无病生存期(disease free survival,DFS)和总生存期(overall survival,OS)预后评价,采用Kaplan-Meier曲线计算生存率,Log-rank检验比较生存差异,单因素和多因素Cox回归分析预后影响因素。采用双侧检验,P<0.05为差异有统计学意义。结果:969例HER2阴性乳腺癌中,HER2低表达者606例(62.54%)、HER2零表达者363例(37.46%)。与HER2零表达组相比,HER2低表达组的N分期(P=0.001)和TNM分期更高(P=0.044),非特殊型组织学类型占比(82.7%vs.79.1%,P=0.009)和组织学分级更高(P=0.048),激素受体阳性率偏高(83.2%vs.75.2%,P=0.003),Ki-67增殖指数>30%者的比例偏低(30.4%vs.36.6%,P=0.044)。两组间DFS及OS差异无统计学意义(P>0.05)。969例患者中,激素受体阳性777例,激素受体阴性(即三阴性乳腺癌)192例。激素受体阳性的777例中,HER2低表达504例(64.9%),HER2零表达273例(35.1%),两组比较,HER2低表达组的发病年龄小(P=0.016),未绝经者占比高(P=0.029),淋巴结受累更多(P=0.002),TNM分期更高(P=0.031),小叶癌和黏液癌组织学类型较少见(3.6%vs.7.3%,4.8%vs.10.6%,P<0.001),DFS和OS差异无统计学意义(P>0.05)。192例激素受体阴性(三阴性乳腺癌)中,HER2低表达102例(53.1%),HER2零表达90例(46.9%),两组比较,HER2低表达组的�Objective:There is an increasing interest in human epidermal growth factor receptor 2(HER2)low expression breast cancer with the result of novel anti-HER2 antibody-drug conjugates for breast cancer.HER2 low expression breast cancer is expected to become a new type of breast cancer.This study analyzed and compared the clinicopathological features and survival data of breast cancer with HER2 low expression group[immunohistochemistry(IHC)1+or IHC 2+,and fluorescence in situ hybridization(FISH)negative]and HER2 zero expression group(IHC 0),in order to explore the difference in clinical biology of HER2 low expression breast cancers.Methods:Among 1250 female patients with primary non-metastatic breast cancer admitted to the Breast Disease Center of Peking University First Hospital from January 2014 to December 2017,969 cases were HER2 negative(IHC 0,1+,2+,and FISH was not amplified).The clinicopathologic features and prognosis of the patients with HER2 low expression(IHC 1+or 2+,and unamplified by FISH)and HER2 zero expression(IHC 0)were analyzed.Disease free survival(DFS)and overall survival(OS)were evaluated,survival rates were calculated by Kaplan-Meier curve,and survival differences were compared by Log-rank test.Cox regression analysis of univariate and multivariate prognostic factors.Bilateral test was used,and P<0.05 was considered statistically significant.Results:In the 969 patients with HER2 negative breast cancer,606 had HER2 low expression(62.54%)and 363 had HER2 zero expression(37.46%).Compared with breast cancer with HER2 zero expression,those with HER2 low expression had higher N stage(P=0.001)and TNM stage(P=0.044),the proportion of non-specific histological types was higher(82.7%vs.79.1%,P=0.009),the histological grade was higher(P=0.048),and the positive rate of hormone receptor was higher(83.2%vs.75.2%,P=0.003).The percentage of Ki-67 value index>30%was lower(30.4%vs.36.6%,P=0.044).There was no significant difference in DFS and OS between the two groups(P>0.05).In the 969 cases,777 were hormone recep

关 键 词：乳腺癌 人表皮生长因子受体2 低表达 临床病理特征 预后 

分 类 号：R737.9[医药卫生—肿瘤]