钙化型乳腺癌的分子分型特点及其预后分析

Analysis of molecular typing and prognosis of breast cancer with calcification

目的分析乳腺癌分子分型的临床特点及其与钙化X线征象的关系,为临床精准医疗提供更多参考信息。方法回顾性分析南方医科大学南方医院2012年1月至2017年10月期间数字乳腺X线摄影发现可疑病灶并经病理证实的631例乳腺癌患者的临床资料,分析不同分子分型的临床特点及预后情况。提取其中376例钙化乳腺癌患者的临床资料,探讨乳腺癌的微钙化X线特征与分子分型的关系。结果乳腺癌分子分型在钙化、淋巴结转移、病理分型上的差异有统计学意义(P<0.05);Her⁃2过表达型及Luminal B型乳腺癌多伴有钙化;Luminal B型和三阴性型多伴淋巴结转移;Her⁃2过表达型、Luminal B型及三阴性型以浸润性癌多见;在不同年龄层上则差异无统计学意义(P>0.05)。在钙化的形态及分布方面差异有统计学意义(P<0.05);Her⁃2过表达型大多呈细小多形性或线样分支状,Luminal B型则为细小多形性居多,两者均以线样、段样分布多见;三阴性型则成簇分布更为多见。分子分型是影响钙化型乳腺癌患者预后的因素。Luminal B型的钙化乳腺癌患者淋巴结转移风险更高(OR=2.753,P=0.050)。结论相对Luminal A型和三阴性型乳腺癌,Her⁃2过表达型和Luminal B型更容易出现钙化征象,且钙化的形态和分布提示恶性程度更高。Luminal B型是钙化型乳腺癌患者预后不良的危险因素之一。分子分型结合钙化征象,可较好地为临床诊断和个性化治疗提供参考。

Objective To analyze the clinical characteristics of breast cancer molecular typing and its rela⁃tionship with calcification,which might provide more significant information for accurate clinical diagnosis and treatment.Method Clinical data of 631 patients with suspicious lesions detected by X⁃ray examination and patho⁃logically confirmed breast cancer in Nanfang Hospital,Southern Medical University from January 2012 to October 2017 were collected.The clinical characteristics and prognosis of different molecular types were analyzed.The clinical data of 376 cases with calcification from 631 breast cancer patients were extracted and the relationship between X⁃ray characteristics of microcalcification and molecular typing of breast cancer were investigated.Results The molecular typing of breast cancer had statistically significant differences in calcification,lymph node metastasis,and pathological typing(P<0.05).Her⁃2 overexpression and Luminal type B breast cancer were mostly associated with calcification.Luminal type B and triple⁃negative type are often associated with lymph node metastasis.Her⁃2 overexpression,Luminal B,and triple⁃negative are more common in invasive cancers.However,there was no significant difference in age stratification(P>0.05).The differences in morphology and distribution of calcification were also statistically significant(P<0.05).Her⁃2 overexpression was mostly small polymorphic or linear branched,while Luminal type B was small polymorphic;both of them are more common in line⁃like and segment⁃like distribution.Triple⁃negative types are more commonly clustered distribution.Molecular typing is a prognostic factor that affects breast cancer patients with calcification.Luminal type B breast cancer patients with calcification have a greater risk of prognostic lymph node metastasis(OR=2.753,P=0.05).Conclusion Compared with Luminal A and triple⁃negative breast cancers,Her⁃2 overexpression and Luminal B are more likely to show signs of calcification.The morphology and distribution of calcification suggest a higher degree of malignancy.Luminal type B is a risk factor for poor prognosis in breast cancer patients with calcification.Molecular typing combined with imaging calcification signs are intended to provide a reference for clinical diagnosis and personalized treatment.