雌激素孕激素受体和人类表皮生长因子受体2在乳腺癌组织中的表达

Expression of estrogen receptor, progesterone receptor, and human epithelial growth factor receptor 2 in breast cancer and the significance thereof： analysis of 910 cases

目的探讨雌激素受体（ER）、孕激素受体（PR）及人类表皮生长因子受体2（HER2）在乳腺癌中的表达及其与年龄、肿瘤大小、临床分期和腋窝淋巴结转移等的相关性。方法对中山大学附属第一医院在2001年1月-2007年12月新收治的910例可手术乳腺癌的ER、PR、HER2及各种临床指标进行回顾性分析。结果在910例的乳腺癌中，浸润性导管癌占89．4％，浸润性小叶癌占1．7％，导管原位癌占5％，其他类型占4．9％；肿瘤直径〈2cm占29．9％，在2～5cm之间的占45．6％，〉5cm的占24．5％；无淋巴结转移的占54．2％，3个及3个以下淋巴结转移的占25．5％，4个及4个以上淋巴结转移的占20．3％。ER表达阴性的占33．0％，PR表达阴性的为27．4％，HER2表达为＋＋＋的占20．1％。随着患者年龄的增长，其就诊时淋巴结癌转移率减小（P〈0．001），其他指标与年龄无明显相关性；肿瘤大小与淋巴结癌转移率呈正相关（P〈0．001），与ER及PR的表达呈负相关（P〈0．001），与HER2表达呈正相关（P=0．02）；ER与PR表达呈正相关（P〈0．001）；ER及PR与HER-2呈明显负相关（P〈0，001）。在不同淋巴结转移状态的乳癌中，ER、PR及HER2的表达差异无统计学意义。结论ER、PR可作为乳腺浸润性导管癌预后良好的重要指标与HER2的表达呈负相关，HER-2的表达与年龄及淋巴结转移状态无明显的相关关系，临床上能更早期发现ER及PR阳性或HER2阴性的肿瘤。

Objective To investigate the expression of estrogen receptor （ER）, progesterone receptor （PR） , and human epithelial growth factor receptor 2 （HER2） in breast cancer,and to explore their correlation with the age of patient, and size, clinic stage, and lymph node metastasis of the tumor. Methods The data of 910 breast cancer, 89. 4% of invasive ductal carcinoma, 1.7% of invasive lobular carcinoma, 44 cases 5% of ductal carcinoma in situ, and 4. 9% of other pathologic types, 29. 9% being less than 2 cm, 45.6% being 2 -5 cm, and 24. 5% bigger than 5 cm in size, 54. 2% without metastasis in lymph node, 25.5% with metastasis in 1 -3 lymph nodes, and 20.3% with metastasis in more than 3 lymph nodes respectively, were analyzed retrospectively. Immunohistochemistry was used to detect the expression of ER, PR, and HER2. Results The ER negative expression rate was 33.0% , and PR negative expression rate was 27.4% , and HER2 overexpression rate was 20. 3%. The possibility of lymph node metastasis decreased along with the increase of age （ P 〈 0. 001 ）. Tumor size was negatively correlated with the expression of ER and PR （both P 〈 0. 001 ） , and positively correlated with the expression of HER2 （P 〈 0. 001 ）. There was no significant difference between the situation of lymph node metastasis and the expression of ER, PR and HER2 in primary tumors. Conclusion As good prognostic markers of breast invasive ductal cancer, ER and PR are negatively correlated with the HER2 expression, as a worse prognostic marker. ER/PR positive or HER？. negative tumors are morel likely to be diagnosed at earlier stages.