三阳型乳腺癌的临床病理特征和预后

Clinicopathologic features and outcomes of triple-positive breast cancer

目的分析三阳型乳腺癌的临床病理特征和影响预后的因素。方法回顾性分析434例浸润性乳腺癌患者的临床资料。根据ER、PR、HER-2及Ki-67的免疫表型将浸润性乳腺癌分为腔面A型、腔面B型、三阳型、三阴型和HER-2过表达型。结果三阳型乳腺癌共56例(12.9%),其与腔面A型乳腺癌患者相比年龄偏小,组织学分级高,淋巴管浸润的机率较大,淋巴结转移率亦较高(P均<0.05),其与腔面B型乳腺癌患者相比,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示肿瘤直径(>5 cm)、淋巴管浸润和分子分型(主要为三阳型乳腺癌)是淋巴结转移的独立预测因子。三阳型乳腺癌患者容易同时出现2个以上部位转移。腔面A型乳腺癌患者预后最好,其次是腔面B型,三阳型乳腺癌患者的无病生存期(diseasefree survival,DFS)和总生存期(overall survival,OS)明显低于腔面A型(P=0.004,P=0.024)。HER-2过表达型和三阴型乳腺癌患者预后最差,三阳型乳腺癌患者的OS虽然高于HER-2过表达型,但差异无统计学意义(P=0.067)。结论三阳型乳腺癌更容易发生淋巴结转移,预后可能是腔面型乳腺癌中最差的,内分泌治疗也难以改善患者预后。

Purpose To investigate the clinicopathologic features and outcomes of triple-positive breast cancer （TPBC）. Methods Complete clinicopathologic data and follow-up data of a total of 434 patients with invasive breast cancer were analyzed. Immunohistochemical （IHC） markers for estrogen receptor （ER）, progesterone receptor （PR）, HER-2, and Ki-67 proliferation index were used to classify cases into five molecular subtypes. The clinicopathologic features and outcomes of TPBC were analyzed by some statistical methods compared to the other four subtypes. Results Of all the patients, 12. 9% were TPBC. The patients with triple-positive subtype had significantly younger age, higher grade, more lymphovascular invasion and more LN positive status than those with Luminal A subtype （ P 〈 0. 05）, whereas there was no significant difference compared to those with Luminal B subtype （ P 〉 0. 05）. Multivariate logistic regression revealed tumor size （ 〉 5 cm） , lymphovascular invasion and molecular subtype （ mainly being triple-positive subtype） to be independent predictors of LN involvement. The rate of metastasis with more than two sites was mainly in the cases of recurrence and metastasis with triple-positive subtype. Luminal A subtype had the best survival, closely followed by Luminal B. However the disease-free survival （DFS） and overall survival （OS） curve for patients with triple-positive were significantly lower than those with Luminal A （P = 0. 004 and P = 0. 024, respectively）. The HER-2-enriched subtype and Tripe-negative had the poorest prognosis, but the OS curve of triple-positive subtype was not significantly higher than that of HER-2-enriched subtype （ P = 0. 067 ）. Conclusions Triple-positive subtype is more likely LN positive, has a worse outcome than other ER ＋ subtype in the luminal group and is hard to derive significant benefits from endocrine therapy in determining survival.