ER/PR阴性乳腺癌的临床病理特征及预后

Clinicopathological characteristics and prognostic significance of the Basal-like subtype of invasive breast carcinoma

目的探讨非激素依赖性乳腺癌的临床病理特征及预后相关因素。方法收集213例1999年1月至2006年12月术前未接受任何治疗的ER、PR阴性乳腺癌患者的临床、病理资料,随访追踪患者生存信息。应用组织微阵列技术、免疫组织化学染色及免疫荧光技术,检测HER2、CK5/6、CK14、EGFR、p53、p63、Vimentin标记物的表达,依据免疫组织化学及免疫荧光检测结果,将213例非激素依赖性乳腺癌进行分类,分析非激素依赖性乳腺癌的临床病理特征及预后因素。结果 213例非激素依赖性乳腺癌中纯HER2过表达型56例(26.3%),基底细胞样型93例(43.7%),Basal-HER2型19例(8.9%),全阴型45例(21.1%)。基底细胞样型乳腺癌患者的3、5、10年无病生存率(DFS)分别为80.6%、77.5%、74.2%;3、5、10年总生存率(OS)分别为82.7%、79.6%、74.1%。在非激素依赖性乳腺癌中基底细胞样型乳腺癌与非基底细胞样型乳腺癌的5年总体生存率相比无明显差异(P>0.05)。基底细胞样型乳腺癌手术时有腋窝淋巴结转移与无转移者5年生存率差异有显著性(64.1%对88.4%,P<0.05)。结论基底细胞样型乳腺癌具有独特的免疫表型及临床病理特征,总体预后与其他类型的非激素依赖性乳腺癌无明显差异,但手术时有无腋窝淋巴结转移对预后影响较大。

Objective To investigate the clinicopathological characteristics and prognosis of hormone receptor breast cancer.Methods 213 cases of hormone receptor-negative breast cancer were collected,which never receive adjunctive therapy.Using tissue microarray immunohistochemistry methods and flourescence in situ hybridization,according to the expression of HER2 and basal markers,we categorized 213 consecutive hormone receptor-negative invasive breast cancers into 4 subtypes.Expression of p53,p63,vimentin was assessed immunochemically.The clinicopathological features and prognosis of those patients were retrospectively evaluated.Results Four subtypes were classified： Pure-HER2 breast cancers 56（26.3%）,Basal-like breast cancers 93（43.7%）,Basal-HER2 breast cancers 19（8.9%）,null phenotype 45（21.1%）.The 3-,5-and 10-year disease-free survival（DFS） was 80.6%,77.5%,74.2% respectively.The corresponding overall survival（OS） rate was 82.7%,79.6%,74.1% respectively.No significant difference was found in 5-year survival among basal-like and the other hormone receptor-negative phenotypes.Basal-like tumors appear to have a relatively good 5-year survival,but survival after metastases is poor.Conclusion Basal-like breast cancers identified by microarray profiling are unusual subtype of invasive breast cancer,with unique immunophenotype,distinctive morphological features,no significant difference was found in 5-year survival among basal-like and the other hormone receptor-negative phenotypes,but survival after node metastases is poor.