三阴乳腺癌的临床特征及预后的研究

Clinical features and prognosis of triple-negative breast cancer

目的探讨三阴乳腺癌(ER、PR、Her-2均为阴性)的临床特征及预后。方法随机抽取山东省立医院1995年10月～2000年10月间的手术切除石蜡包埋标本116例,采用免疫组化技术,检测p53、Her-2、VEGF、EGFR蛋白表达情况,并做三阴乳腺癌与临床特征及预后相关性分析。结果116例乳腺癌患者中三阴乳腺癌22例,占19.0%。三阴乳腺癌与肿瘤大小、淋巴结转移数目、组织学分级、p53、EGFR蛋白均相关(P<0.05),与年龄、月经状况、VEGF蛋白无相关性。中位随访96(32～123)个月, 22例三阴乳腺癌患者中,有12例(54.5%)发生复发转移,而94例非三阴乳腺癌患者中,20例(21.3%)发生复发转移(P<0.05)。三阴乳腺癌表达不同的患者间总生存时间(OS)有统计学差异(P<0.05),而无病生存时间差异无统计学意义(P=0.2877)。Cox模型多因素回归分析显示,肿瘤大小、淋巴结转移数、组织学分级、是否为三阴乳腺癌是预测总生存率的独立预后因素。结论三阴乳腺癌通过免疫组化方法确定,有特定的临床特征,预后明显差于对照。其临床较为有效的治疗方法尚不明确,有待进一步深入研究。

To demonstrate the clinical features and prognosis of triple-negative breast cancer.Methods The immunohistochemical staining method was adopted to examine the expressions of ER, PR, p53, Her-2, VEGF, and EGFR protein in 116 samples of breast cancer tissues. Results 22 triplenegative breast cancer occoured in 112 cases （ 19. 0% ） obtained from october 1995 to october 2002. Triple - negative breast cancer was significantly co and rrelated with tumor size, grade, lymph node metastasis and protein p53, and EGFR （P 〈 0. 05）, but not with age, menopause, protein VEGF. Follow-up（range： 32 - 123 months; median： 96 months）, 12 triple - negative breast cancer patients relapsed distantly, while 20 patients without triple - negative phenotype relapsed distantly （P 〈 0. 05 ）. Survival analysis showed that triple - negative phenotype was reversely associated with overall survival （ P 〈 0. 05 ）, but not significantly with disease free survival （ P = 0. 2877）. Multivariate Cox model analysis showed that tumor size, lymph node status, histological grade, and triple - negative phenotype provided independent predictive power. Condusions Triple-negative breast cancer has specific clinical and biologi and cal features, and the prognosis was poor.