孕激素受体缺失对可手术雌激素受体阳性乳腺癌患者预后的影响

Lack of progesterone receptor expression predicts poor prognosis in patients with operable ER-positive invasive breast cancer

目的：探讨孕激素受体（ PR）缺失对可手术的雌激素受体（ ER）阳性浸润性乳腺癌患者预后的影响。方法回顾性分析318例女性ER阳性浸润性乳腺癌患者的临床病理特征，并根据PR表达状态进行分组。采用单因素和多因素统计分析方法分析其预后影响因素。通过分层分析，进一步明确PR缺失影响的重点人群。结果318例患者中，PR阳性219例，PR阴性99例。318例患者的5年生存率为92．5％，5年无病生存率为87．2％。其中PR阳性组和阴性组患者5年生存率分别为94．6％和87．8％，差异有统计学意义（P＝0．020）；5年无病生存率分别为89．8％和81．6％，差异有统计学意义（P＝0．019）。单因素分析显示，肿瘤大小、pT分期、淋巴结转移数目、临床分期、PR表达是影响患者总生存的因素（均P＜0．05）；pT分期、淋巴结转移数目、临床分期、PR表达是影响患者无病生存的因素（均P＜0．05）。多因素分析显示，pT分期、淋巴结转移数目、PR表达是影响ER阳性浸润性乳腺癌患者无病生存和总生存的独立因素（均P＜0．05）。分层分析显示，肿瘤≤2 cm或Ⅰ期患者的PR状态与预后无关（均P＞0．05）。绝经前患者中，PR阴性较PR阳性患者的总生存和无病生存差（均P＜0．05）。结论 PR缺失是可手术ER阳性女性乳腺癌患者预后不良的独立因素。当肿瘤＞2 cm或分期较晚或患者处于绝经前状态时，PR缺失将发挥更强的预后预测作用。

Objective To investigate the impact of lack of progesterone receptor （ PR） expression on the prognosis of patients with operable ER （ estrogen receptor）-positive invasive breast cancer. Methods We retrospectively analyzed the clinicopathological features, treatment and survival data of 318 women with ER＋/PR＋ and ER＋/PR- invasive breast cancer. Results Among the 318 patients, there were 219 PR-positive and 99 PR-negative cases. The 5-year overall survival （ OS ） rate was 92. 5%, and the 5-year disease-free survival （ DFS） rate was 87. 2% in the 318 ER-positive patients. Among them, the 5-year OS rates were significantly different between the PR-positive group （94.6%） and PR-negative group （87.8%, P=0.020）, and the 5-year DFS rates were also significantly different from each other （89.8% and 81.6%, respectively, P=0.019）.Univariate analysis showed that PR status, tumor size, T stage, axillary lymph node metastasis, and clinical stage were prognostic factors for OS （ P〉0.05 for all） . Multivariate analysis showed that lack of PR expression, T stage ≥2, and positive axillary lymph node metastasis were independent risk factors for poor DFS and OS in ER-positive breast cancer patients （ P〉0. 05 for all ） . Subgroup analysis showed that lack of PR expression was not significant in predicting poor DFS or OS when patients were in stageⅠ or with a small tumor （≤2 cm） （P〈0.05 for all）, and also showed that premenopausal women with PR-negative disease had poorer DFS and OS than PR-positive patients （ P〈0.05 for both） . Conclusions Lack of PR expression is an independent risk factor for poor prognosis in patients with operable ER-positive invasive breast cancer, especially in patients with a large tumor （〉2 cm） , advanced clinical stage （ StageⅡ or Ⅲ） or in premenopausal status.