三阴性乳腺癌的临床病理特征与预后分析

Clinical-pathological characteristics and survival of triple negative breast cancer

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）三者均阴性乳腺癌，即三阴性乳腺癌的临床病理特征，三阴性乳腺癌与非三阴性乳腺癌的预后差异以及可能的机制。方法选择复旦大学附属肿瘤医院1993至1997年病理确诊的乳腺癌690例，年龄27～86（52±12）岁，其中三阴性乳腺癌127例，占所有病例18．41％。回顾性分析三阴性与非三阴性乳腺癌的临床病理特征：年龄、亲属乳腺癌、伴随其他肿瘤、抑癌基因P53蛋白表达、表皮生长因子受体（EGFR）蛋白表达、伴随良性肿瘤、双乳癌、临床分期、病理类型、淋巴结转移、远处转移以及进行生存分析。结果三阴性乳腺癌P53及EGFR阳性表达率分别71．42％和59．74％，明显高于非三阴性乳腺癌（P〈0．01，P=0．013）；三阴性乳腺癌更易淋巴结转移（P=0．048）。三阴性乳腺癌与非三阴性乳腺癌5年总生存率为79．67％比88．59％，10年总生存率为63．15％比83．28％。三阴性乳腺癌与非三阴性乳腺癌总生存率差异有统计学意义（P=0．001）。三阴性乳腺癌与非三阴性乳腺癌5年无瘤生存率为77．94％比83．82％，10年无瘤生存率为62．87％比82．53％。三阴性乳腺癌与非三阴性乳腺癌无瘤生存率差异有统计学意义（P=0．011），尤以36个月以内更为显著。结论三阴性乳腺癌与非三阴性乳腺癌相比，P53、EGFR表达显著增多。三阴性乳腺癌更易淋巴结转移。三阴性乳腺癌患者总生存率及无瘤生存率明显低于非三阴性乳腺癌。

Objective To investigate the chnical-pathological characteristics of triple negative breast cancer. Methods The clinical-pathological characteristics of 690 breast cancer patients, all females, 127 being estrogen receptor （ER）, progesterone receptor （PR）, and human epidermal growth factor receptor （HER）-2 triple negative, were analyzed. Results The expression rate of P53, a tumor suppressor gene, of the triple negative breast cancer patients was 71.42% （75/127） , significantly higher than that of the non-triple negative breast cancer patients （42. 56% , P 〈 0.01 ） , and the expression rate of epidermal growth factor receptor （EGFR） of the triple negative breast cancer was 59. 74%, significantly higher than that of the non-triple negative breast cancer patients （ 22. 06% , P = 0. 013 ） . The local lymph node metastasis rate of the triple negative breast cancer was 22. 22%, significantly higher than that of the non-triple negative breast cancer patients （2. 70%, P = 0. 048）. The 5-year overall survival （OS） rate and 10- year OS rate of he triple negative breast cancer patients were 79.67% and 63.15% respectively, both significantly lower than those of the non-triple negative breast cancer patients （88. 59% and 83.28% respectively, both P = 0. 001 ）. The 5-year and 10-year disease free survival （ DFS ） rates of the triple negative breast cancer patients were 77.94% and 62. 87% respectively, both significantly lower than those of the non-triple negative breast cancer patients （ 83.82% and 82. 53% respectively, both P = 0. 011 ）, especially that within 36 months. Conclusion Triple negative breast cancer is related with P53 and EGFR expression, and tends to metastasize to local lympho-nodes. The survival rate of triple negative breast cancer patients is significantly lower than that of non-triple negative breast cancer.