不同分子分型乳腺癌的临床特征及预后分析

Clinical characteristics and prognosis analysis of different subtypes of breast cancer

目的探讨不同分子分型乳腺癌的临床特点以及预后。方法收集重庆医科大学附属第二医院2009年1月至2012年4月收治的乳腺癌患者中有完整临床病历和随访资料的手术女性乳腺癌患者247例,根据雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)、ki-67的表达情况将乳腺癌分为Luminal A型、Luminal B型、HER-2过表达型和三阴性型4个类型,分析各临床特征对预后的差异及影响预后的因素。结果 Luminal A型117例(47.4%)、Luminal B型56例(22.7%)、Her-2过表达型15例(6.1%)和三阴性型59例(23.9%),各分子分型在组织分级、肿瘤直径、靶向治疗的差异有统计学意义(P<0.05)。对各类型转移部位差异进行Fisher确切概率计算,提示Luminal B型、三阴性型转移率较其他类型高,分别为19.6%、17.0%,其中转移部位以骨转移最为常见,但各类型转移部位的差异无统计学意义(P>0.05)。采用COX回归分析单因素、多因素分析结果显示肿瘤分期、脉管侵犯是影响乳腺癌患者总生存率和无病生存率的独立预后因素。结论不同分子分型乳腺癌的临床病理不同,其中luminal B型、三阴性型乳腺癌预后较差。

Objective To investigate the clinical characteristics and prognosis analysis of different molecular subtypes of breast cancer. Methods Clinical data of 247 patients with histopathologically confirmed resectable breast cancer,who were treated in our hospital from January 2009 to April 2012,were collected and analyzed in this study. The molecular subtypes were categorized as Luminal A subtype,Lumihal B subtype,human epidermal growth factor receptor-2（ HER-2） over-expression subtype and triple negative subtype based on the expression of estrogen receptor（ ER）,progesterone receptor（ PR）,HER-2 and ki-67 protein. The correlation of prognosis of different molecular subtypes was analyzed. Results Among the 247 cases of breast cancer,Luminal A,Lumihal B,HER-2 over-expression and triple negative subtypes accounted for 117 cases（ 47. 4%）,56 cases（ 22. 7%）,15 cases（ 6. 1%） and 59 cases（ 23. 9%）,respectively. There were statistically significant differences in the tissue grading,tumor size and targeted therapy among different molecular subtypes（ P〈0. 05）. Fisher exact calculation of metastatic sites of each subtype suggested that the metastasis rates of Luminal B and triple negative subtypes were 19. 6% and 17. 0%,respectively,higher than those of the other subtypes. The most common metastasis site was bone metastasis,without statistically significant differences among different subtypes（ P〉0. 05）. Univariate and multivariate analysis showed that organization classification and pathological types were independent prognostic factors affecting the disease free survival and the overall survival. Conclusion Different subtypes of breast cancer have different clinical characteristics. Luminal B and triple negative subtypes have poor prognosis.