雌、孕激素受体和表皮生长因子受体2在乳腺癌分型中的应用

Hormone receptors and Her-2 status in breast cancer

目的研究乳腺癌分子亚型的临床病理特征及预后。方法SP法检测509例手术切除的乳腺癌雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）、表皮生长因子受体2（erbB-2，Her-2）表达并对其分型，1-ter-2-、ER／PR＋为腔上皮样A亚型（Luminal A），Her-2＋、ER／PR＋为腔上皮样B亚型（Luminal B），Her-2-、ER-、PR-为三阴性型（Triple—negative）、Her-2＋、ER-、PR-为ERBB2＋亚型（ERBB2＋）。x^2检验比较亚型的临床病理特征，Kaplan—Meier法分析5年无瘤生存率（DFS），单因素和Cox多因素分析与复发和转移相关的因素。结果Luminal A占所有病例40．5％（206／509），Luminal B占18．5％（94／509），Triple—negative占21．4％（109／509），ERBB2＋19．6％（100／509）。三阴性型乳腺癌中髓样癌的比例高于其他类型乳腺癌（P〈0．05），4种亚型复发转移率差异有统计学意义（P=0．029）。多因素分析发现淋巴结状态和临床分期是独立的预后影响因素（P=0．000）。ERBB2＋和Triple—negative的DFS分别为81％、78．9％，低于LuminalA和LuminalB的DFS（88．8％、90．4％）（P=0．025）。结论在本组乳腺癌患者中，LuminalA亚型所占比例最高，Triple—negative和ERBB2＋复发转移率高，预后较LuminalA和LuminalB亚型差。

Objective To observe clinicopathological features and prognosis of suptypes in breast cancers. Methods SP method was applied on 509 operated breast cancer patients to examine ER,PR and Her-2 status which determined subtypes. Subtype definitions were as follows： Her-2 - , ER ＋ and/or PR ＋ as Luminal A, Her-2 ＋ , ER ＋ and/or PR ＋ as Luminal B, Her-2 - , ER - PR - as Triple-negative, Her-2 ＋, ER -, PR - as ERBB2 ＋. X^2 test was applied to determine their association with clinicopathological features. Kaplan-Meier method was used to analyze disease free survival （DFS）. Univariate regression and COX multivariate regression were preformed to analyze association between metastasis or recurrence and cfiniopathological features. Results 40. 5% of all cases （206/509） were identified as Luminal A, 18.5% （94/509） as Luminal B, 21.4% （109/509） as Triple-negative, 19.6% （100/509） as ERBB2 ＋. The rate of medulary type in triple negative breast cancer was higher than that in other subtypes （ P 〈 0. 05 ）. Significant difference in the rate of recurrence or metastasis was found among four subtypes （ P = 0. 029 ）. Cox regression analysis suggested that lymph node status and TNM stage were independent factors affecting the prognosis（P =0. 000）. DFS of ERBB2 ＋ and Triple-negative was 81.0% and 78.9% respectively, which was lower than that of Luminal A and Luminal B （88.8% ,90.4% ） （ P = 0. 025 ）. Conclusion Luminal A occurred at the highest prevalence. Triple-negative and ERBB2 ＋ have a higher incidence of relapse or metastasis and poorer prognosis than Luminal A and Luminal B.