三阴性乳腺癌临床病理特征及预后与淋巴结转移的相关性

Relationship between clinicopathologic characteristics and prognosis of ttriple-negative breast cancer and lymph node status

目的分析三阴性乳腺癌(triple-negative breast cancer,TNBC)临床病理特征及预后与淋巴结转移的相关性。方法将382例可手术乳腺癌患者根据淋巴结转移情况分组,有淋巴结转移的为阳性组,无转移的为阴性组;利用免疫组织化学方法对ER、PR、Her-2蛋白表达进行检测,根据其结果分别将淋巴结阳性组和阴性组再分为两组,一组为TNBC,另一组为非三阴性乳腺癌(non-triple-negative breast cancer,non-TNBC),比较TNBC和non-TNBC的临床病理特征,Kaplan-Meier法分析乳腺癌的5年无瘤生存率。结果21.5%(82/382)的病例为TNBC,淋巴结阳性者为163例(42.7%),其中TNBC占43例,淋巴结阴性者为219例(57.3%),其中TNBC为39例。TNBC的淋巴结阳性率(52.4%)高于non-TNBC(40.0%),两者差异有统计学意义(P=0.044)。在淋巴结阳性组中,TNBC较non-TNBC肿瘤直径大(P=0.014),在淋巴结阴性组中,TNBC中有乳癌家族史的比例要高(P=0.030),其它临床病理特征差异无显著性(P>0.05)。淋巴结阳性组5年无瘤生存率TNBC组为60.5%,non-TNBC组为76.7%,差异有统计学意义(P=0.041);淋巴结阴性组5年无瘤生存率TNBC组为74.4%,non-TNBC组为88.3%,差异有统计学意义(P=0.023)。结论无论淋巴结转移情况,TNBC比non-TNBC易发生复发和转移,临床预后差。

Purpose To analyze the relationship between clinicopathologic characteristics and prognosis of triple-negative breast cancer （TNBC）and lymph node status. Methods According to the lymph node status,the 382 patients with histopathologically confirmed resectable breast cancer were divided into the positive and the negative group. Respectively, according to the ER,PR and Her-2 expression by immunohistochemistry method,the two group were divided into TNBC group and the non-triple-negative breast cancer（non-TNBC） group. The clinicopathologic characteristics and survival status of each group were compared. The 5-year disease-free survival （DFS） was analyzed by Kaplan-Meier methods. Results Of the 382 patients,21.5% （82/382） had TNBC,42.7% （163/382） had lymph node metastasis in which 43 patients had TNBC, and 57.3% （219/382） didn＇t have lymph node metastasis in which 39 patients had TNBC. The percentage of cases with lymph node metastasis was higher in TNBC than in non-TNBC （P =0. 044）. In lymph node positive group the tumor diameter of TNBC was larger than the non-TNBC （P =0. 014）, and in lymph node negative group there was a high- er proportion of family history of breast cancer（ P = 0. 030）. NO significant difference was found in other clinicopathologic characteristics （ P 〉 0. 05 ）. The 5-year DFS were significantly lower in TNBC patients than in non-TNBC patients both in lymph node positive group and in lymph node negative group（60. 5% vs 76. 7%, P = 0. 041 ;74.4% vs 88. 3%, P = 0. 023 ）. Conclusions Regardless of lymph node status, compared with non-TNBC ,TNBC has an increased possibility of recurrence or metastasis,leading to a poorer prognosis.