不同分子分型乳腺癌行保乳乳癌根治术的预后分析

Analysis of the Prognosis of Breast-conserving Resection for Different Molecular Subtype Breast Cancer

目的探讨不同分子分型对行保乳乳癌根治术乳腺癌患者预后的影响。方法回顾分析郑州大学附属洛阳中心医院2010年9月—2013年9月期间收治的182例行保乳乳癌根治术乳腺癌患者的临床资料。根据标本免疫组化结果将患者分为4组:Luminal A型[雌激素受体(ER)+/孕激素受体(PR)+/表皮生长因子受体(HER)2-,Ki-67<14%)],Luminal B型(ER+/PR+/HER2-,Ki-67>14%),HER2+型(ER-/PR-/HER2+)和三阴性(TNBC)(ER-/PR-/HER2-);比较各组别之间生存率、复发率及远处转移率等预后因素。结果 182例保乳根治术患者中,Luminal A型81例,Luminal B型38例,HER2+型23例和TNBC 40例,其中局部复发患者20例,局部复发率11%,出现远处转移20例,转移率11%,死亡18例,生存率90.1%。统计结果表明不同年龄、分子分型、淋巴结转移情况、组织学分级、肿瘤大小等单因素分析在生存率、局部复发率和远处转移率上差异有统计学意义(P<0.05),多因素分析结果显示不同年龄、分子分型、淋巴结转移情况、组织学分级为独立预后因素(P<0.05),肿瘤大小不是影响其生存率的独立预后因素(P=0.082)。结论不同分子分型乳腺癌患者行保乳乳癌根治术后预后不同,Luminal A型预后最好,TNBC患者预后最差,但是保乳根治术对TNBC患者仍是一种可行治疗方案。

Objective To investigate the affect of different molecular subtype for the prognosis of breast cancer patients who had accepted Breast-conserving resection. Methods Clinical data of 182 breast cancer patients who had accepted breast-conserving resection and was submitted in Luoyang Central Hospital affiliated to Zhengzhou University from September 2005 to September 2013 were retrospectively analyzed. According to Specimens immunohistochemical results, the patients were divided into four group, Luminal A （ER＋/PR＋/HER2-,Ki-67﹤14%）, Luminal B （ER＋/PR＋/HER2-,Ki-67﹥14%）, HER2＋（ER-/PR-/HER2＋） and TNBC （ER-/PR-/HER2-）. Prognosis factors such as survival rate, recurrence rate, distant metastasis rate and so on of the four groups were compared. Results In the 182 patients who had accepted breast-conserving resection, 81 cases were Luminal A, 38cases were Luminal B, 23 cases were HER2＋, and 40 cases were TNBC. Among the 182 cases, local recurrence appeared in 20 cases , accounting for 11%, distant metastasis appeared in 20 cases, accounting for 11%, decease appeared in 18cases , Survival rate accounted for 90.1%. Statistical results indicated that differences on survival rate, local recurrence and distant metastasis rate of univariate analysis such as different ages, molecular subtype, lymph node metastasis, histological grade and tumor size were statistically significant （P〈0.05）. Multivariate analysis indicated that different ages, molecular subtype, lymph node metastasis, histological grade were independent prognostic factors （P〈0.05）, and tumor size was not independent prognostic factors that can affect survival rate. Conclusion Breast cancer patients with different molecular subtypes who have accepted breast-conserving resection have different prognosis, Luminal A have the best prognosis, and TNBC patients have the worse prognosis, but breast-conserving resection remain a feasible therapeutic regimen for TNBC patients.