PCR检测Ⅰ期HER-2阳性乳腺癌患者腋窝淋巴结HER-2表达的意义

Clinical Significance of HER-2 Expression Detection by PCR in Axillary Lymph Nodes of StageⅠBreast Cancer with HER-2-postive

【目的】探讨聚合酶链反应(PCR)检测对Ⅰ期人表皮生长因子受2(HER-2)阳性乳腺癌腋窝淋巴结HER-2表达检出率的影响及其表达与腋窝淋巴结微转移与预后的关系。【方法】收集两院住院资料完整的128例女性Ⅰ期HER-2阳性乳腺癌患者的临床病理资料,采用PCR检测患者腋窝淋巴结HER-2表达并进行随访,用Kaplan-Meier法进行生存结果分析。【结果】本组128患者病理诊断均为非特殊型浸润性乳腺癌、HER-2阳性、雌激素受体(ER)和孕激素受体(PR)阴性。随访期间,局部复发3例,远处转移13例,其中10例发生转移的患者在随访过程中死亡,无病生存(DFS)为89.1%(114/128)。128例中腋窝淋巴结HER-2PCR检测86例阴性,42例阳性。HER-2PCR阳性组和阴性组患者基线临床特征比较差异均无统计学意义(P>0.05)。阳性组DFS为78.6%(33/42),阴性组DFS为94.2%(81/86),二组相比较差异有统计学意义(P<0.05)。阳性组采用曲妥珠单抗治疗27例,DFS为92.6%(25/27),未用15例,DFS为53.3%(8/15),二组DFS比较差异有统计学意义(P<0.05)。阴性组用曲妥株单抗58例,DFS为96.6%(56/58),未用28例,DFS89.3%(25/28),两组DFS比较差异无统计学意义(P>0.05)。【结论】腋窝淋巴结HER-2PCR阳性提示患者有微转移,有微转移的患者预后比无微转移的预后差,曲妥珠单抗可改善有腋窝淋巴结微转移患者预后。

【Objective】Polymerase chain reaction(PCR)can improve the detection rate of micrometastasis.To detect HER-2 expression by PCR in axillary lymph nodes of stageⅠHER-2-postive breast cancer and study its clinical significance.【Methods】The clinical and pathological data of 128 cases of stageⅠbreast cancer with HER-2-postive expression were collected.HER-2 gene expression levels in axillary lymph nodes were detected by PCR.The clinicopathological characteristics,treatment and prognosis were retrospectively analyzed by using the statistical methods such as Kaplan-Meier.【Results】The pathological type of 128 cases was infiltrative non-specific carcinoma with HER-2 positive expression and negative expression of ER and PR.During follow-up,3 patients had local recurrence,13 had distant metastases,and 10 patients had distant metastases who died during follow-up.DFS(disease-free survival)rate was 89.1%(114/128).PCR detection of HER-2 showed that 42 cases were positive expression and 86 cases were negative expression in axillary lymph nodes.The clinicopathological characteristics were not statistically different between the two groups(P>0.05).DFS rate was 78.6%(33/42)in HER-2 positive expression group and 94.2%(81/86)in HER-2 negative expression group,respectively;The difference of DFS rate was statistically significant(P<0.05).In HER-2 positive expression group,27 patients received trastuzumab treatment and the DFS rate was 92.6%(25/27),while the DFS of 15 patients without receiving trastuzumab was 53.3%(8/15).The difference in DFS between the two groups was statistically significant(P<0.05).In HER-2 negative expression groups,DFS rate was 96.6%(56/58)in 58 cases who received trastuzumab and 89.3%(25/28)in 28 cases without receiving trastuzumab.The DFS rate of two groups had no significant difference(P>0.05).【Conclusion】Overexpression of HER-2 implies the indication of axillary lymph node micrometastasis.Breast cancer patients with HER-2 positive expression in axillary lymph node have poor prognosis.Trastuzumab can improve the prognosis of patients with micrometastasis of axillary lymph nodes.