乳腺癌不同分子亚型腋窝淋巴结转移的状态及预后分析

Axillary Lymph Nodes Metastasis of Various Breast Cancer Molecular Subtypes and Its Prognostic Analysis

目的探讨乳腺癌不同分子亚型腋窝淋巴结转移的状态及预后分析。方法对2005年1月2007年12月收治的125例乳腺癌患者进行分子分型,对腋窝淋巴结转移状态进行分析并结合随访结果进行预后分析。结果 Luminal A型63例,16例淋巴结转移,转移率为25.4%;Luminal B型19例,7例淋巴结转移,转移率为36.8%;HER-2过表达型26例,11例淋巴结转移,转移率为42.3%;Basal-like型17例,9例淋巴结转移,转移率为52.9%。其中Luminal A型淋巴结转移率与Basal-like型比较差异有统计学意义(P<0.05),其余型间比较差异无统计学意义(P>0.05)。运用χ2检验各分子亚型在肿瘤大小的差异无统计学意义(P>0.05)。经过2～5年随访,8例患者出现局部复发或远处转移,其中Luminal B型2例,HER-2过表达型5例,Basal-like型1例。8例中有3例因肝转移死亡,另5例接受治疗现仍生存。结论乳腺癌的分子分型可作为腋窝淋巴结转移的预测指标,HER-2过表达型和Basal-like型预后较差,将为今后制定乳腺癌个体化治疗提供重要依据。

Objective To analyze the axillary lymph nodes metastasis of various breast cancer molecular subtypes and its prognosis.Methods Molecular subtypes of 125 cases of operable breast cancer diagnosed and treated between January 2005 and December 2007 were categorized,and the axillary lymph nodes metastasis of these types was analyzed.At the same time,we analyzed its prognosis status with the results of the follow-up.Results Among the 125 cases,there were 63 luminal A cases in which 16（25.4%） were found to be axillary lymph nodes metastasis.Among the 19 luminal B cases,there were 7（36.8%） axillary lymph nodes metastases.There were 11 cases（42.3%） of axillary lymph nodes metastasis in the 26 cases of HER-2（＋） subtype.In the 17 cases of basal-like subtye,9（52.9%） were axillary lymph nodes metastases.As for the axillary lymph nodes metastatic rate,only basal-like subtype was higher than luminal A subtype with a statistically significant difference（P0.05）.Differences between all other subtypes were not significant（P0.05）.The molecular subtypes did not differ in tumor size（P0.05） according to the result of chi-square test.During the 2 to 5-year follow-up,8 of the 125 patients were found to have local tumor recurrence or distant metastatic disease,which included 2 luminal B cases,5 HER-2（＋） subtype cases,and 1 basal-like subtype case.In those 8 patients,3 died of liver metastases and 5 survived and are still accepting treatment now.Conclusion Molecular subtyping can provide important information of axillary lymph nodes metastatic status.HER-2 over-expression and basal-like subtype have a poor prognosis,which is an important basis for individual treatment of breast cancer in the future.