年轻乳腺癌患者的病理学和生物学特征及其与预后的关系

Clinicopathological and biological features of breast cancer in young females and their relationship with prognosis

目的 分析与年轻乳腺癌患者预后相关的临床、病理学及生物学因素，筛选预后不良因素。方法 回顾性分析≤35岁女性原发性乳腺癌99例，收集临床资料，复习病理切片相关指标，并对其中63例蜡块完整者采用免疫组化方法检测雌激素受体（ER）、孕激素受体（PR）、雄激素受体（AR）、c-erbB2、ki67、p53和BRCA1蛋白表达。结果 99例均随访5年，随访率100％。全组淋巴结转移率为59．6％（59／99），5年远处转移率为28．0％（26／93），5年生存率为72．7％（72／99）。单因素分析显示，淋巴管侵犯、软组织受累、广泛性导管内癌成分（EIC）、淋巴结受累及AR、c-erbB2表达对预后有影响。多因素Cox回归分析表明，淋巴结受累状况、AR和c-erbB2表达是独立预后因素。结论 淋巴结状况和c-erbB2表达是影响年轻乳腺癌患者预后的独立预后因素，AR可作为一种辅助预后因子，人为干预不能从根本上影响患者转归。

Objective To study the relationship between clinicopathological and biological characteristics and prognosis in young females with breast cancer. Methods The clinicopathological data of 99 young patients （≤35years） with primary breast cancer were analyzed retrospectively. All the 99 patients were followed up for 5 years. The histological specimens were reviewed. The expression of ER, PR, AR, c- erbB2, ki67, p53 and BRCA1 were assessed by immunohistochemistry in 63 carcinomas. Results The lymph node involvement, 5-year metastasis and 5-year survival rate were 59.6% （59/99）, 28.0% （26/ 93） and 72.7% （72/99）, respectively. The univariate analysis showed that the survival was related to lymphatic vessel invasion, fat involvement, node-positive status, EIC, AR and c-erbB2 expression. The COX multivariate analysis identified that only node-positive status, AR negativity and c-erbB2 overexpression were independent prognostic factors. Conclusion Our data demonstrated that the lymph node status and c- erbW2 expression are strong prognostic factors in young patients with breast cancer. AR may be an adjuvant prognostic factor. The therapeutic measurement could not benefit the outcome radically.