激素受体阳性/人表皮生长因子受体2阴性乳腺癌临床病理特征及预后

Clinicopathological features and prognosis of hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer

目的:探讨激素受体阳性/人表皮生长因子受体2阴性(hormone receptor-positive/human epidermal growth factor receptor 2-negative,HR+/HER2-)乳腺癌患者临床病理特征及预后。方法:收集2008年1月至2017年12月北京大学第一医院乳腺疾病中心连续诊治的3035例浸润性乳腺癌患者,对临床病理信息完善的HR+/HER2-患者的重要临床病理参数及其预后意义进行分析。结果:1920例(63.26%)HR+/HER2-乳腺癌患者中资料完善者1624例,其中124例(7.64%)出现复发转移,63例死于该病,5年总生存率和无病生存率分别为93.0%及92.6%。pT1及2期占92.80%,pN0期占69.03%;组织学非特殊型占89.66%,分级1、2、3级分别为30.11%、55.60%和14.29%;ER阴性、低表达、高表达患者分别占1.60%、2.09%、96.31%,PR阴性、低表达、高表达分别占6.83%、10.47%、82.70%;Ki67指数<10%、≥10%且<20%、≥20%者分别占19.52%、32.02%和48.46%。预后及生存分析显示,pT1期复发转移风险较pT3组低,pT2和pT3组较pT1组无病生存期(disease-free survival,DFS)短,易复发转移;pN0、pN1及pN2期复发转移风险均较pN3期低,与DFS呈负相关;组织学1及2级复发转移风险较3级低,与DFS呈负相关;Ki67指数≥20%更易复发转移。ER在HR+/HER2-乳腺癌中预后意义不明显,但PR阴性和低表达更易复发转移,生存分析显示,PR表达水平<10%患者的DFS及总生存期(overall survival,OS)最短,10%~60%次之,>60%最长。124例复发转移者以骨转移多见(55例,44.35%),而肝转移者(30例,24.20%)预后最差。结论:本研究表明,pT分期、pN分期、组织学分级、HR表达水平、Ki67指数等临床病理参数是HR+/HER2-乳腺癌的重要预后因素,但意义有所不同,其中pN分期和组织学分级有独立预后价值,PR阳性表达水平具有重要预后和风险预测价值,随PR表达水平升高(<10%、10%~60%、>60%),DFS及OS递增,复发转移风险递减,PR表达>60%者DFS及OS最长,复发转移风险最低,PR危险性分层具有独立预后意义。

Objective:To investigate the clinicopathological features and prognosis of hormone receptor-positive(HR+),human epidermal growth factor receptor 2-negative(HER2-)breast cancer.Methods:In the study,3035 consecutive breast cancer patients diagnosed in Breast Disease Center,Peking University First Hospital from January 2008 to December 2017 were collected.The prognostic signi-ficance of important pathological factors in HR+/HER2-patients with complete clinicopathological information was analyzed.Results:Within the 1920(63.26%)cases of HR+/HER2-breast cancer,there were 1624 cases with complete clinicopathological data,of which,124 cases(7.64%)recurred and/or metastasized and 63 cases died of the disease,and the 5-year overall survival(OS)rate and disease-free survival(DFS)rate was 93.0%and 92.6%respectively.The stage of pT1-2 was 92.80%,while pN0 was 69.03%.89.66%cases belonged to histologically non-specific type and 30.11%,55.60%,14.29%were credited to Grade 1,2 and 3 respectively.The distribution of ER negative,low or high expression groups were 1.60%,2.09%and 96.31%,while PR were 6.83%,10.47%,82.70%,respectively.The group of Ki67 index<10%was 19.52%,≥10%&<20%for 32.02%,≥20%for 48.46%.Survival analysis showed that cases with pT1 stage had lower risk of recurrence than those with pT3,while cases with pT2 and pT3 had shorter DFS than those with pT1,with higher risk of recurrence and metastasis.Analysis proved that both pN stage and histological grade were negatively correlated with DFS.The cases with pN0,pN1 and pN2 were lower risk of recurrence than those with pN3,while cases with Grade 1 and 2 had lower risk of recurrence than cases with Grade 3.And the group of Ki67 index≥20%showed higher risk of recurrence and metastasis.The prognostic significance of ER expression in HR+/HER2-breast cancer was not significant.However,the negative/low PR expression groups showed higher risk of recurrence and metastasis,of which PR<10%group had shortest DFS and OS,followed by 10%-60%group and then>60%group.The most common site of metastasis was bone(55 cases,44.35%),while cases with liver metastasis(30 cases,24.20%)had the worst outcome.Conclusion:Our study revealed that pT,pN,Grade,HR expression level and Ki67 index were important prognostic factors for HR+/HER2-breast cancer,although there are variables in prognostic value.Factors of pN and Grade showed independent prognostic significance.PR expression level had prognostic significance for the risk of recurrence and metastasis.The stratified level of PR expression(<10%,10%-60%,>60%)had independent prognostic value,showing successively longer DFS and OS,lower risk of recurrence.PR>60%group had the longest DFS and OS as well as the lowest risk of recurrence.