HER-2低表达的非特殊型浸润性乳腺癌的临床病理特征与腋窝淋巴结转移的危险因素分析

Clinicopathological features of invasive breast cacinoma of no special type with low expression of HER-2 and risk factors of axillary lymph node metastasis

目的探讨人类表皮生长因子受体2(HER-2)低表达的非特殊型浸润性乳腺癌(IBC)的临床病理特征,并分析腋窝淋巴结(ALN)转移的相关危险因素。方法回顾性分析2018年1月至2022年12月在绍兴市妇幼保健院确诊为HER-2阴性的111例非特殊型IBC患者的临床病理资料。其中HER-2免疫组化(IHC)判读为1+或2+且荧光原位杂交未扩增者归为HER-2低表达组(77例),HER-2 IHC判读为0者归为HER-20表达组(34例)。比较两组患者临床病理特征,并采用多因素logistic回归分析影响ALN转移的危险因素。结果HER-2低表达组患者年龄(52.8±10.9)岁、肿瘤大小通常≤2.5 cm、主要位于外上象限、以临床分期Ⅰ/Ⅱ期和组织学Ⅱ级为主。HER-2低表达组患者雌激素受体、孕激素受体、雄激素受体(AR)阳性率及Luminal B型占比均高于HER-20表达组,差异均有统计学意义(均P<0.05)。HER-2低表达组患者ALN转移与肿瘤大小(>2.5 cm)、AR阴性表达状态、Ki-67高表达(≥20%)、Luminal B型、临床分期(Ⅱ/Ⅲ期)均有关(均P<0.05);HER-20表达组患者ALN转移仅与临床分期(Ⅱ/Ⅲ期)有关(P<0.05)。多因素logistic回归分析显示AR阴性表达状态和Luminal B型是影响HER-2低表达组患者ALN转移的危险因素(均P<0.05)。结论HER-2低表达患者具有一定的临床病理特征,激素受体表达状态和分子分型特点均有别于HER-20表达患者,其ALN转移关联的危险因素包括AR阴性表达状态和Luminal B型。

Objective To analyze the clinicopathological features of invasive breast cacinoma of no special type(IBC-NST)with low expression of human epidermal growth factor receptor 2(HER-2)and the risk factors associated with axillary lymph node(ALN)metastasis.Methods The clinicalpathologic data of 111 IBC-NST patients with HER-2 negative expression admitted to Shaoxing Maternity and Child Health Care Hospital from January 2018 to December 2022 were retrospectively analyzed.The patients were categorized into the HER-2 low expression group(77 cases)if their HER-2 immunohistochemical(IHC)interpretation was 1+or 2+and fluorescence in situ hybridization was not amplified,and into the HER-20 expression group(34 cases)if their HER-2 IHC interpretation was 0.The clinicaopathological features were compared between two groups,the risk factors associated with ALN metastasis were analyzed with multivariate logistic regression.Results Patients in the HER-2 low expression group were(52.8±10.9)years,the tumors were mainly located in the outer upper quadrant with a tumor size of≤2.5 cm,clinical stage ofⅠ/Ⅱand histological grade ofⅡ.Compared with the HER-20 expression group,the positive rate of estrogen receptor,progesterone receptor,androgen receptor(AR)and the proportion of Luminal B type were significantly higher in HER-2 low expression group(all P<0.05).In the HER-2 low expression group,ALN metastasis was associated with tumor size(>2.5 cm),AR negative expression status,high Ki-67 expression(≥20%),Luminal B subtype,and clinical stage(Ⅱ/Ⅲstages)(all P<0.05);in the HER-20 expression group,ALN metastasis was only associated with clinical stage(Ⅱ/Ⅲstages)(P<0.05).Multivariate logistic regression analysis showed that AR negative expression status and Luminal B subtype were risk factors for ALN metastasis in HER-2 low expression group(both P<0.05).Conclusion HER-2 low expression patients have certain clinicopathological features that differ from those of HER-20 expression patients,including hormone receptor expression status and molecular subtype features.The risk factors associated with ALN metastasis in these patients include AR negative expression status and Luminal B subtype.