激素受体和人表皮生长因子受体2的表达与改良根治术后淋巴结阳性乳腺癌患者预后的关系

Prognostic value of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 in node positive breast cancer patients treated by mastectomy

目的 探讨雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（Her-2）的表达情况与行改良根治术后腋窝淋巴结阳性乳腺癌患者预后的关系.方法 收集835例行改良根治术后腋窝淋巴结阳性乳腺癌患者的临床和随访资料.根据ER、PR和Her-2的免疫组化检查结果,将患者分为Rec^-/Her-^2-（三阴性）组、Rec^-/Her-^2＋组、Rec^＋/Her-^2＋组和Rec^＋/Her-^2-组,比较其局部区域复发率、远处转移率、无瘤生存率和总生存率.结果 835例患者中,三阴性组141例,Rec^-/Her-^2＋组99例,Rec^＋/Her-^2＋组157例,Rec^＋/Her-^2-组438例.Rec^＋/Her-^2-患者的5年局部区域复发率为6.2%,低于其他患者（12.9%,P=0.004）.与受体阳性组（Rec^＋/Her-^2＋和Rec^＋/Her-^2-）比较,受体阴性组（Rec^-/Her-^2-和Rec^-/Her-^2＋）有较高的5年远处转移率（26.4%和19.7%,P=0.0008）、较低的5年无瘤生存率（66.7%和75.6%,P=0.0001）和较低的5年总生存率（71.4%和84.2%.P=0.0000）.多因素Cox回归分析结果显示,激素受体和Her-2的表达状态是乳腺癌患者局部区域复发、远处转移、无瘤生存和总生存的独立影响因素（均P〈0.05）,Rec^＋/Her-^2-患者的局部区域复发风险低,受体阴性患者发生远处转移和死亡的风险高.结论 ER、PR和Her-2是改良根治术后腋窝淋巴结阳性乳腺癌患者的独立预后因素.

Objective To evaluate the prognostic value of estrogen receptor （ER）, progesterone receptor （ PR） and human epidermal growth factor receptor-2 （ Her-2） in node-positive breast cancer patients treated by mastectomy. Methods The clinicopathological data of 835 breast cancer patients treated by mastectomy from January 2000 to December 2004 were retrospectively analyzed. All had positive axillary nodes without distant metastases and with the immunohistochemistry staining of ER, PR and Her-2 available. 764 （91.5%） patients received anthracycline- and/or taxanes-based chemotherapy. 464 （55.6%） patients received hormonal therapy. Eight （1 % ） patients received trastuzumab. Postmastectomy radiotherapy were given to 352 out of 437 （80. 5% ） patients with T3-T4 and/or N2-N3 disease and 68 out of 398 （20. 9% ） patients with T1-2N1 disease. Patients were classified into 4 subgroups according to the status of hormone receptors （ER and PR, Rec） and Her-2： Rec^-/Her-^2- （triple negative） , Rec^-/Her-^2＋ , Rec^＋/Her-^2＋ and Rec^＋ /Her-^2-. End points were isolated locoregional recurrence （LRR）, distant metastases （ DM ） , disease-free survival （DFS） and overall survival （OS）. Results 141 （16.9% ） patients were Rec^-/Her-^2- , 99 （11.9%） Rec^-/Her-^2＋, 157 （18.8%） Rec^＋/Her-^2＋ and 438 （52.5% ）Rec^＋/Her-^2-. Patients with Rec^＋ /Her-^2- breast cancer had a significantly lower 5-year LRR rate than others （6.2% vs. 12.9%, P = 0. 004）. Compared with patients with Rec^＋ breast cancer, patients with Rec- breast cancer had significantly higher 5-year DM rate （26. 4% vs. 19. 7% , P =0. 0008） , lower DFS rate （66. 7% vs. 75. 6% , P = 0.0001） and lower OS rate （71.4% vs. 84.2%, P= 0.0000）. In multivariate analysis, Rec^＋/Her-^2- was significantly associated with lower risk of LRR. Rec- was an independent prognostic factor for higher risk of DM, decreased DFS and OS. Conclusion ER, PR and Her-2 are independent prognostic factors for locoregional recurrence and survival in node-positive breast cancer patients treated by mastectomy.