三阴性乳腺癌与HER-2过表达乳腺癌患者的临床病理特征及预后比较

Comparative study on clinicopathologic characteristics and prognosis between triple-negative and HER-2-overexpressed breast cancer

目的探讨三阴性乳腺癌与HER-2过表达乳腺癌患者的临床病理特征及预后。方法回顾1997年1月至2007年1月行手术治疗的725例原发性乳腺癌的临床资料，根据免疫组化染色结果确定三阴性和HER-2过表达乳腺癌表型，并对2组的临床病理学资料进行比较和生存分析。结果三阴性和HER-2过表达乳腺癌分别占12．29％及24．96％；三阴性乳腺癌有恶性肿瘤家族史者占18．4％，明显高于HER-2过表达组的5．5％（P=0．001）；组织学分级3级者占54．0％，也高于HER-2过表达组42．0％（P=0．01）；三阴性乳腺癌（74．7％）较HER-2过表达乳腺癌（64．6％）更易发生淋巴结转移（P=0．045）；在2年内复发、转移及脑转移（分别为25．3％及8．0％）明显高于HER-2过表达乳腺癌（分别为8．8％和2．2％）（P〈0．05），其5年无病生存率（55．6％）明显低于HER-2过表达乳腺癌（69．8％）（P=0．041）。2组在年龄、月经状态、肿瘤大小、病理分期、手术方式、病理类型、辅助放化疗、肝柿骨转移比例和总生存率之间差异均无统计学意义（P〉0．05）。结论与HER-2过表达乳腺癌相比，三阴性乳腺癌更多有恶性肿瘤家族史，肿瘤恶性度更高，更易发生淋巴结和脑转移，无病生存期更短，预后差。

Objective To compare clinicopathological characteristics and prognosis between triple-negative and HER-2-overexpressed breast cancer patients. Methods From Jan. 1997 to Jan. 2007, data of 725 cases of primary breast cancer patients undergoing surgical treatment were analyzed. The patients were classified into triple-negative and HER-2-overexpressed phenotypes based on immunohistochemistry results. The clinicopathological characteristics and survival of the 2 groups were compared. Results Of the 725 cases, triple-negative and HER-2-overexpressed phenotypes accounted for 12. 29% and 24. 96% respectively. Compared with HER-2-overexpressed group, the triple-negative group had significantly higher proportion of familial history of malignancy （ 18.4% vs 5.5% , P =0. 001 ） and higher proportion of patients＇ histological grade reaching grade 3 （54. 0% vs 42. 0% , P = 0. 01 ）. There were more lymph node metastasis in triple-negative group than that in HER-2-overexpression group （ N1 ＋ N2 ＋ N3 ： 74. 7% vs 64. 6% , P = 0. 045）. The recurrence and metastasis rate within 2 years and brain metastasis rate in triple-negative group were higher than those in HER-2-overexpressed group （25.3%, 8.0% vs 8.8% , 2. 2%, respectively, P 〈0. 05）. The 5-year disease-free survival rate in triple-negative group was significantly lower than that in HER-2-overexpressed group （ 55.6% vs 69. 8% , P = 0. 041 ）. There was no statistical difference between the 2 groups in terms of age, menopausal status, tumor size, pathological stage, surgical procedure, pathological type, adjuvant radio-chemotherapy, the proportion of metastasis to liver, lung and bone as well as overall survival rate （ P 〉 0. 05 ）. Conclusion Compared to HER-2-overexpressed group, patients with triple-negative breast cancer show higher rate of familial history of malignancy, andthey are associated with higher histological grade and poor prognosis.