雌激素受体阴性乳腺癌中人表皮生长因子受体2与孕激素受体表达的关系

Association of Human Epidermal Growth Factor Receptor 2 and Progesterone Receptor Expression in the Estrogen-receptor Negative Breast Cancer Patients

目的研究雌激素受体(ER)阴性的乳腺癌患者中人表皮生长因子受体2(Her-2)和孕激素受体(PR)表达的关系以及对预后的影响。方法对1180例乳腺癌患者进行回顾性分析,确立ER状态,将PR与Her-2表达的关系进行比较,综合p53和上皮性钙黏蛋白(E-cadherin)状态以及发病年龄、肿瘤直径、肿瘤部位、组织学分级、淋巴结转移状态、是否化疗之间的差异。对影响ER阴性乳腺癌患者无病生存率(DFS)的相关因素进行分析。结果三阴性乳腺癌96例,Her-2过表达乳腺癌164例,PR+/Her-2+10例,PR+/Her-2-28例。三阴性乳腺癌较Her-2过表达乳腺癌更容易发生淋巴结转移(P=0.034),并且三阴性乳腺癌中淋巴结转移≥10枚患者所占的比例(26.0%)明显大于Her-2过表达乳腺癌(12.2%)。三阴性乳腺癌中组织学分级为3级的患者比例明显高于Her-2过表达乳腺癌(P<0.0001)。三阴性乳腺癌和Her-2过表达乳腺癌的局部复发率和远处转移率的差异虽无统计学意义,但三阴性乳腺癌的无病生存期(61.85个月)明显短于Her-2过表达乳腺癌(78.69个月,P=0.047)。结论与Her-2过表达乳腺癌比较,三阴性乳腺癌的临床表现为侵袭性更强,患者的无病生存期更短,预后更差。

Objective We studied the clinicopathologic characteristics and disease - free survival （DFS） for estrogen receptor - negative（ ER - ） breast cancer by comparing the status of human epidermal growth factor receptor -2（ Her- 2） and progesterone reeeptor （PR）. Methods ER - negative expression was identified from 1180 breast cancer patients diagnosed between 2000 and 2007 in Chang- hai Hospital （Shanghai）. We examined differences between triple - negative and Her -2 - overexpressing breast cancers in relation to p53 and E - cadherin status, age, tumor size, histological grading, lymph node metastasis and chemotherapy, as well as identified prognostic factors with regards to DFS. Results We identified cases of 96 （12.5%） triple -negative and 164 （21.3%） Her- 2 -overexpressing phenotypes,respectively. No significant difference in p53 or E -cadherin expression between the triple -negative and Her- 2 -overexpressing breast cancer was found （ P 〉 0.05 ）. Women with triple negative breast cancer experienced more lymph node metastases （71.9% ： 58.5% ,P =0.034）, with the higher percentage of more than 10 lymph nodes metastases（26.0% ）as compared with Her -2 - overexpressing breast cancer （ 12.2% , P = 0. 034）. A higher percentage of histological grade 3 was identified in triple - negative （67.7%） than in Her - 2 - overexpressing breast cancer（42.1% ,P 〈 0. 0001 ）. No significant difference in local recurrence rate, distant metastasis rate or incidence of recurrence and metastasis between the two phenotypes was found （P 〉 0.05）. However, significantly poorer 5 -year DFS was seen in patients with triple negative phenotype （61.85 months）than with Her- 2 -overexpressing phenotype （78.69 months,P =0.047）. Conclusion Triple -negative breast cancers were more aggressive, and these women had poorer DFS comparing with Her - 2 - overexpressing ones.