雌孕激素受体阴性乳腺癌分子亚型的临床及病理特点
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[摘要] 目的 分析HER-2阳性型和三阴性两种雌孕激素受体阴性乳腺癌亚型的临床特征和预后状况，探讨多因素对激素受体阴性乳腺癌预后的影响，以及激素受体阴性乳腺癌个体化综合治疗的理论基础。 方法 收集2005年1月～2011年7月南京医科大学附属无锡市妇幼保健院收治的81例激素受体阴性乳腺癌的临床病理资料，根据免疫组织化学方法（IHC）检测的人类表皮生长因子受体2（HER-2）状态，分为两组：ER、PR、HER-2三阴性组和HER-2阳性组（IHC 3+）。回顾性分析两组患者的临床病理特征和预后情况。 结果 三阴性乳腺癌51例，HER-2阳性乳腺癌30例。平均发病年龄分别为49.7、52.7岁。三阴性组临床分期为Ⅲ期及淋巴结转移的患者比例明显低于HER-2阳性组比例（P < 0.05）。三阴性组的肿瘤大小、脉管浸润、VEGF阳性率均低于HER-2阳性组，但差异无统计学意义（P > 0.05）；三阴性组的组织学高级别、P53阳性率高于HER-2阳性组，但差异无统计学意义（P > 0.05）。两组随访7～83个月，12例患者发生复发或死亡。单因素分析显示，激素受体阴性乳腺癌患者的无病生存期与淋巴结状态、脉管浸润有关；多因素分析显示，脉管浸润是激素受体阴性乳腺癌患者的独立预后指标。 结论 激素受体阴性乳腺癌中，三阴性乳腺癌和HER-2阳性乳腺癌有各自的临床病理特点。脉管浸润情况是激素受体阴性乳腺癌复发的独立影响因素。
[关键词] 乳腺癌；三阴性；人类表皮生长因子受体2；临床病理特征；预后；免疫组织化学
[中图分类号] R737.9 [文献标识码] C [文章编号] 1673-7210（2012）08（b）-0097-04
Clinical and pathological characteristics analysis for hormone receptor negative breast cancer molecular subtype
DING Yun1 LU Xiaowei1 MA Tao1 YIN Yongxiang2 CHEN Daozhen1 LIU Xiao3
1.Department of Breast, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Jiangsu Province, Wuxi 214002, China; 2.Department of Pathology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Jiangsu Province, Wuxi 214002, China; 3.Department of Thyroid, Breast Surgery, Wuxi People′s Hospital Affiliated to Nanjing Medical University, Jiangsu Province, Wuxi 214023, China
[Abstract] Objective To analyze the clinical features of different hormone receptor negative breast cancer subtypes HER-2 positive and triple-negative subtype), to investigate the prognostic factors of hormone receptor negative breast cancer, and try to find the evidence of combined and individualized treatment for patients with hormone receptor negative breast cancer. Methods Clinical data of 81 patients with hormone receptor negative breast cancer, treated in Wuxi maternity and child health hospital affiliated Nanjing medical university from January 2005 to July 2011,were collected and analyzed in this study. According to the HER-2 status detected by immunohistochemistry, the patients were divided into two groups: the group of triple negative, the group of HER-2 positive (IHC 3+). The difference of the clinicopathological features and prognosis among the two groups were compared. Results 51 cases were triple-negative breast cancers, 30 cases were HER-2 positive breast cancers, the average age of patients with the two subtype was 49.7 and 52.7 respectively. Compared with the group of HER-2 positive, the group of triple negative and decreased significantly in the ratio of lymph node metastasis and clinical stage Ⅲ (P ＜ 0.05). There was no significant difference in size of cancer, vascular invasion, the positive rate of VEGF and P53, high level of histolog (P ＞ 0.05). The follow-up duration ranged from 7 months to 83 months, 12 cases of them were found to have local tumor recurrence or distant metastatic disease. The univariate analysis showed that lymph node metastasis and vascular invasion were correlated with the disease-free survival of hormone receptor negative breast cancer. However, only vascular invasion was showed to be an independent prognostic factor assessed by multivariate analysis. Conclusion Patients with different subtype of hormone receptor negative breast cancer have different the clinicopathological features. The vascular invasion is an independent prognostic factor of the patients with hormone receptor negative breast cancer.