Luminal A型乳腺癌原发灶与淋巴结转移灶表型标志物差异性研究

Difference of biological markers between primary tumor and metastatic axillary lymph node of Luminal A subtype breast cancer

目的目前临床主要依据乳腺癌原发灶的分子分型制定治疗方案,而淋巴结转移与患者预后密切相关。本研究旨在探讨Luminal A型乳腺癌原发灶与腋窝淋巴结转移灶之间表型标志物的差异性表达情况。方法收集2012-03-01-2014-11-30中国医科大学附属第一医院手术治疗的70例乳腺癌患者组织标本,所有患者均经病理确诊原发灶为Luminal A型乳腺癌并伴有淋巴结转移。采用免疫组织化学方法检测70例患者对应的全部转移淋巴结ER、PR、HER2和Ki-67的表达情况,探讨原发灶与淋巴结转移灶之间表型标志物表达的差异性。结果 70例原发灶为Luminal A型乳腺癌患者中,淋巴结转移灶与原发灶表型标志物差异率为32.86%(23/70)。在原发灶与转移灶中,ER表达不一致6例,变化率为8.57%(6/70);PR表达不一致7例,变化率为10.00%(7/70);HER2表达不一致8例,变化率为11.43%(8/70);Ki-67表达不一致12例,变化率为17.14%(12/70)。区域淋巴结转移数目与原发灶和淋巴结转移灶间表型标志物的变化呈正相关,r=0.396,P=0.003;并与Ki-67(r=0.405,P=0.003)及PR(r=0.279,P=0.042)变化呈正相关。结论本研究结果提示,目前仅依据原发灶分子表型标志物制定综合治疗方案可能并不确切,需综合考虑,从而降低肿瘤异质性带来的低估风险。

OBJECTIVE At present,treatment program is mainly based on the molecular subtype of primary breast cancer.However,lymph node metastases is deeply related to prognosis.This study aims to detect the difference of biological markers between primary tumor and metastatic axillary lymph node of Luminal A subtype breast cancer.METHODS Primary tumor tissue and metastatic lymph node specimens were obtained from 70 patients with Luminal A subtype breast cancer at Department of Breast Surgery,First Hospital of China Medical University,from 2012 to 2014.All metastatic axillary lymph nodes were detected by using four biomarkers including estrogen receptor（ER）,progesterone receptor（PR）,HER2,and Ki-67 by immunohistochemistry.RESULTS The seventy cases of iuminalA subtype primary tumor shifted to other subtype metastatic lymph nodes with worse prognostic in 23 of 70 cases（32.86%）.ER was expressed inconsistently between the primary tumor and metastatic lymph node in 6 cases of these patients,the change rate was 8.57%（6/70）.PR was expressed inconsistently between the primary tumor and metastatic lymph node in 7 cases of these patients,the change rate was 10.00%（7/70）.HER2 was expressed inconsistently between the primary tumor and metastatic lymph node in8 cases,the change rate was 11.43%（8/70）.Ki-67 was expressed inconsistently between the primary tumor and metastatic lymph node in 12 cases,the change rate was 17.14%（12/70）.The number of metastatic lymph node has positive correlation with the change of biological markers between primary tumor and metastatic lymph node,r=0.396,P=0.003.The number of metastatic lymph node had positive correlation with the change of Ki-67 and PR index（r=0.405,P=0.003;r=0.279,P=0.042）.CONCLUSIONS At present,It may be incomplete to develop a comprehensive treatment program only according to the primary tumor phenotype markers.The molecular subtypes in the metastatic nodes should be taken into account in order to reduce tumor heterogeneity risk.