人表皮生长因子受体2表达对腋淋巴结阳性和阴性乳腺癌患者预后的不同影响

Different influence of Her-2 expression on the prognosis in node-positive and node-negative breast cancer

目的 探讨人表皮生长因子受体2（Her-2）表达在腋淋巴结阳性和阴性乳腺癌患者预后中的意义.方法 采用抗Her-2单克隆抗体CB11进行免疫组化,检测981例原发性乳腺癌肿瘤组织Her-2蛋白的表达,分析其与乳腺癌预后的关系.结果 981例原发性乳腺癌Her-2蛋白的阳性表达率为19.7%（193/981）,Her-2表达水平与乳腺癌患者的发病年龄、雌激素受体（ER）和孕激素受体（PR）表达状态明显相关（P〈0.05）.单因素分析显示,在腋淋巴结阳性的乳腺癌患者中,Her-2表达与预后显著相关,Her-2阳性者的5年无病生存（DFS）率和5年总生存（OS）率分别为48.8%和55.2%,Her-2阴性者分别为66.9%和76.4%,差异均有统计学意义（P〈0.01）.而在腋淋巴结阴性的患者中,Her-2表达与患者的5年DFS率和5年OS率均无显著相关性（P〉0.05）.多因素分析显示,在腋淋巴结阳性的乳腺癌患者中,Her-2表达水平是影响乳腺癌OS的独立因素,但不是影响乳腺癌DF5的独立因素.结论 在腋淋巴结阳性乳腺癌患者中,Her-2表达水平是重要的预后因素.

Objective To investigate the prognostic significance of Her-2 expression in node-positive and node-negative breast cancer in Chinese women. Methods The Her-2 expression in breast cancers from 981 patients was detected by immunohistochemistry with anti-Her-2 （CB11） monoclonal antibody. The survival curves were analyzed by Kaplan-Meier method, and Cox regression model was applied to determine whether this factor is an independent predictor of survival in multivariate analysis. Results Nineteen point seven percent of the patients showed positive Her-2 expression in their tumors. Patients with Her-2-positive tumors tended to be younger. The high level Her-2 expression was significantly associated with negative estrogen receptor and progesterone receptor status in their tumors （ P 〈0.05 ）. Among 387 patients with node-positive disease, the 5-year disease-free survival （ DFS） rate and 5-year overall survival （OS） rate were significantly lower in patients with Her-2-positive tumors than in patients with Her-2-negative tumors （DFS：48.8% vs. 66.9% ,P =0.009 OS：55. 2% vs. 76.4% ,P =0.001）, and Her-2 expression was an independent unfavorable prognostic factor for OS, but not for DFS in patients with node-positive disease. Among 591 patients with node-negative disease, Her-2 expression was not significantly associated with DFS and OS （P〉0.05）. Conclusion Her-2 expression is an important prognostic factor in patients with node-positive disease, but not for patients with node-negative disease in Chinese women.