High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer

AIM:To assess the clinical significance and the prognostic value of preoperative serum carbohydrate antigen 19-9(CA 19-9)level in gastric cancer.METHODS:Between January 2005 and December2006,1960 patients underwent surgery for histologically confirmed gastric cancer.Of these,163 patients had elevated serum levels of CA 19-9 preoperatively,and1628 patients had normal serum levels of CA 19-9 preoperatively.For this study,325 patients were selected from the group of 1628 patients by age,sex,and cancer stage to serve as controls.Statistically significant differences in survival rates were calculated using the log-rank test.A P value less than 0.05 was considered statistically significant and was determined using SAS software.RESULTS:The baseline characteristics showed some differences between the two groups with regard to histology.Overall survival(OS)in the elevated and nonelevated group was 37.90 and 68.67 mo,respectively(P<0.001).N stage(P=0.001)was a significant predictor of disease-free survival by multivariate analysis.Also,N stage(P<0.001),and the presence of peritoneal metastasis(P<0.001)remained independent factors in predicting OS by multivariate analysis.Additionally,preoperative serum CA 19-9 levels were significantly associated with OS in univariate(P=0.009)and multivariate(P=0.021)analyses.CONCLUSION:Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.

Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients. Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data. Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (<= 35 d) and group B (> 35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283). Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.

Study of Minimal Residual Disease in Adults with B-Lineage Acute Lymphoblastic Leukemia by Flowcytometry

Background: After achieving morphological remission, existence of few number of leukemic cells in the patient’s blood represents the minimal residual disease (MRD) and its monitoring helps in evaluating early treatment response and future relapse. Patients and methods: Eighty seven newly diagnosed (B-ALL) cases were enrolled in the present study in the time period from October 2013 to October 2016. A panel of 4 monoclonal antibodies (CD10FITC, CD19PE, CD34PercP and CD45APC) were defined at diagnosis and after morphological remission for tracing of minimal residual disease (MRD). Results: Eighty seven newly diagnosed B-ALL cases were included in the present study of which 73 (84%) showed positive expression to CD45 in combination with (CD10, CD19 and CD34) at diagnosis, which allow us to use this combination for further assessment of MRD after morphological remission. In our study 65% of patients had negative MRD ( Conclusion: MRD detection by flow cytometry using the combination of CD45 with CD10, CD19 & CD34 is an easy and reliable method. Patients with positive MRD are at higher risk of relapse and have inferior overall survival rates compared to those with MRD-ve. Future studies focusing on treatment intensification for the group of patients with +ve MRD aiming to improve the treatment outcome are warranted.

Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.METHODS Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.RESULTS Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.CONCLUSION Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

乳腺癌组织中TIMP-3及DNMT1的表达与患者预后的相关性

目的:分析研究乳腺癌患者中基质金属蛋白酶组织抑制因子3(TIMP-3)及DNA甲基转移酶1(DNMT1)的表达水平与患者临床预后的相关性。方法:收集58例临床资料完整的乳腺癌手术切除标本,采用免疫组化SP法检测癌组织及相应癌旁组织中TIMP-3、DNMT1、ER、PR、HER-2、p53、Ki-67的表达,将TIMP-3、DNMT1表达水平与临床病理参数及随访生存状况进行相关性分析,所有入组患者均进行随访5年以上。结果:我们发现,在乳腺癌组织中,TIMP-3呈低表达,DNMT1呈高表达,TIMP-3及DNMT1的表达呈负相关;TIMP-3表达水平与Ki-67呈负相关,DNMT1表达水平与Ki-67呈正相关,与其他临床病理参数未见相关性。Cox风险比例模型分析显示只有临床分期和DNMT1表达水平是影响总生存期(OS)和无病生存期(DFS)的独立风险因素。TIMP-3低表达组的5年OS和DFS均显著低于高表达组,DNMT1高表达组的5年OS和DFS均显著低于低表达组。结论:研究表明乳腺癌中TIMP-3及DNMT1表达水平与肿瘤细胞恶性表型及患者生存时间有关,可能成为判断乳腺癌预后的一项重要指标,并作为治疗计划制定的依据。

复发性卵巢癌患者术后血清CA125、D-D水平及残留病灶大小对无瘤生存期的影响

目的 探讨复发性卵巢癌患者术后血清糖链抗原125(CA125)、D-二聚体(D-D)水平及残留病灶大小对无瘤生存期的影响。方法 回顾性分析50例复发性卵巢癌患者的临床资料,随访并记录无瘤生存期。统计患者一般资料及术后血清CA125、D-D水平,分析无瘤生存期影响因素;以Pearson相关系数分析术后CA125、D-D水平及残留病灶大小与无瘤生存期的相关性。结果 不同临床分期、分化程度、化疗疗程、CA125、D-D水平及残留病灶大小的患者无瘤生存期比较,差异有统计学意义(P<0.05);COX回归分析显示,术前临床分期、术后CA125水平、术后D-D水平及术后残留病灶大小是复发性卵巢癌患者无瘤生存期的独立影响因素(P<0.05);Pearson相关性分析显示,术后CA125、D-D水平及残留病灶大小与无瘤生存期均呈负相关(P<0.05)。结论 复发性卵巢癌患者术后CA125、D-D水平及残留病灶大小是影响其无瘤生存期的重要因素。

Breast Cancer Subtypes and Survival in Chinese Women with Operable Primary Breast Cancer

Objective： To investigate the associations between the different breast cancer subtypes and survival in Chinese women with operable primary breast cancer. Methods： A total of 1538 Chinese women with operable primary breast cancer were analyzed in this study, the median follow-up was 77 months. Estrogen receptor （ER）, progesterone receptor （PR）, and HER2 status were available for these patients. Results： Luminal A （ER＋ and/or PR＋, HER2-） had a favorable disease-free survival （DFS） and overall survival （OS） compared with other subtypes in the entire cohort. Using the luminal A as a reference, among the patients with lymph node positive disease, HER2＋ （ER-, PR-, HER2＋） had the worst DFS （hazard ratio, HR=1.80, 95% CI 1.11 to 2.91, P=0.017） and luminal B （ER＋ and/or PR＋, HER2＋） had the worst OS （HR=2.27, 95% CI 1.50 to 3.45, P0.001）; among the patients with lymph node negative disease, triple-negative （ER-, PR-, HER2-） had the worst DFS （HR=2.21, 95% CI 1.43 to 3.41, P0.001）, whereas no significant difference in DFS between HER2＋ and luminal B or luminal A was observed. Conclusion： As compared with luminal A, luminal B and HER2＋ have the worst survival in patients with lymph node positive disease, but this is not the case in patients with lymph node negative disease; triple-negative subtype has a worse survival in both lymph node positive and lymph node negative patients.

Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

BACKGROUND In pancreatic cancer,acute pancreatitis(AP)is a serious morbidity,but its negative effect on long-term outcomes remains to be elucidated.AIM To investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma(PDAC)and tumor-specific survival.METHODS The medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively.The severity of acute pancreatitis was classified according to the Atlanta classification of AP.The patient demographics and tumor characteristics were assessed.Early recurrence was defined as a relapse within 12 mo after surgery.Overall and disease-free survival and recurrence patterns were analyzed.Mild acute pancreatitis was excluded because its negative effects can be negligible.RESULTS Early recurrence in AP group was significantly higher than in non-AP group(71.4%vs 41.2%;P=0.009).Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence[odds ratio(OR):4.13;95%confidence interval(CI):1.41-12.10;P=0.01].The median time to recurrence was shorter in patients with AP than in those without(8.4 vs 12.8 mo;P=0.003).Multivariate analysis identified AP as an independent prognostic factor for overall survival[relative risk(RR):2.35;95%CI:1.45-3.83]and disease-free survival(RR:2.24;95%CI:1.31-3.85)in patients with PDAC.CONCLUSION Patients with moderate or severe acute pancreatitis developed recurrences earlier than those without.Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.

Conservative strategy for treatment of stable coronary artery disease

Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.

Long-term disease-free survival in a dog with appendicular osteosarcoma

Postoperative prognosis is generally poor even with adjuvant chemotherapy in dogs with an appendicular osteosarcoma. The purpose of this report was to present the long-term disease-free survival time in a dog with appendicular osteosarcoma receiving amputation,adjuvant chemotherapy and adoptive immunotherapy. A 12-year-old spayed Golden retriever was referred to our hospital with a suspicion of osteosarcoma in right distal radius. The patient underwent the computed tomography (CT) and incisional biopsy on the next day after the first presentation. The CT revealed the osteolysis in the right distal radius and no metastases in the lungs and lymph nodes. The histopathologic diagnosis was made as an osteosarcoma. On the 13th day after,the patient underwent right forelimb amputation. Six doses of carboplatin (250 mg / m2) were postoperatively administered every 3 weeks. The intravenous infusion of lymphokine-activated killer (LAK) cells suspension was performed every 3 ~ 4 weeks after the adjuvant chemotherapy. At the time of our writing this abstract (on the 880thday after the first presentation),no recurrences and metastases were observed after the 32 transfers of LAK cells. In canine appendicular osteosarcoma,some reports have described that postoperative median survival times were 235 ~ 540 d with adjuvant chemotherapy. In our report,the disease free interval and survival time were prolonged compared with the previous reports. We strongly believed that early diagnosis and surgical intervention and adoptive immunotherapy had a great impact on the improvement of survival time in canine appendicular osteosarcoma.

临床-CT影像组学列线图预测结直肠癌无病生存的价值

目的:构建预测结直肠癌(colorectal cancer,CRC)患者无病生存(disease-free survival,DFS)的临床模型、影像组学模型(radscore)和基于上述两者的联合模型,比较各模型诊断效能。方法:搜集2015年01月至2019年12月间接受增强CT检查和一期根治性手术+辅助化疗的Ⅱ期和Ⅲ期CRC患者资料,DFS者212例,疾病进展(PD)者91例;样本随机分为训练组(n=217例)和验证组(n=86例)。比较临床变量组间差异并建立预测DFS的临床模型;在静脉期CT图像勾画肿瘤三维体积感兴趣区(VOI),提取的影像组学特征经降维、筛选后获得11个最优特征用于建立radscore;并构建临床+radscore联合模型。最优模型以列线图展示,并评估其校准度和临床获益;比较各模型预测DFS的效能。结果:两组间肠梗阻、术前CEA、术前CA199、差分化、T分期、淋巴结转移、脉管侵犯(LVI)、神经侵犯(PNI)、淋巴结清扫数目差异有统计学意义(均P<0.05)。临床模型、radscore、联合模型AUC分别为0.745、0.771、0.842(训练组),0.753、0.738、0.834(验证组)。联合模型显示出较高的校准度,DCA阈值范围0.12~0.90时临床有获益。联合模型AUC均大于临床模型、radscore(均P<0.05)。结论:基于临床变量和CT影像组学构建的列线图可用于预测CRC的DFS,有望成为CRC预后评估的新工具。

Long-term survival and risk factors in esophageal squamous cell carcinoma:A Kaplan-Meier and cox regression study

BACKGROUND The global incidence of esophageal cancer(EC)remains high.Despite advan-cements in medical technology and deeper research into the causes and treatment methods of EC,the effectiveness of treatment for EC is still unsatisfactory.Therefore,it is crucial to address the urgent problem of improving the long-term survival rate of EC patients and providing personalized treatment.AIM To analyze the survival prognosis and influencing factors of esophageal squamous cell carcinoma(ESCC).METHODS A retrospective analysis was conducted on the clinical data of 115 patients with pT3N0M0 ESCC who underwent radical surgery alone from January 1,2013,to December 31,2019.The Kaplan–Meier method was used to evaluate the 1-year,3-year,and 5-year survival rates and median survival time of the patients.The Cox proportional hazards regression model was used to assess the hazard ratios(HRs)and 95%confidence intervals(95%CIs)of risk factors.RESULTS The 1-year,3-year,and 5-year overall survival(OS)rates for the 115 EC patients analyzed were 85.22%,50.43%,and 37.48%,respectively.The median OS was 37.00(95%CI:24.93-49.07)months,and the median disease-free survival was 21.00(95%CI:14.71-27.29)months.Both univariate and multivariate Cox regression analyses revealed that high body mass index(BMI;HR=1.137,95%CI:1.054-1.226),positive perineural invasion(PNI;HR=13.381,95%CI:4.899-36.547),and smoking(HR=2.415,95%CI:1.388-4.203)were independent risk factors for a poor prognosis.In contrast,compared to the upper thoracic location of the tumor,middle thoracic(HR=0.441,95%CI:0.240-0.810)and lower thoracic(HR=0.328,95%CI:0.144-0.750)locations were protective factors.CONCLUSION BMI,tumor location,PNI,and smoking are associated with the prognosis of ESCC patients.This study highlights the prognostic risk factors for T3N0M0 ESCC patients and offers personalized insights for clinical treatment.

急性早幼粒细胞白血病FLT3-ITD突变分析

目的:研究FLT3-ITD突变对于急性早幼粒细胞白血病(APL)远期疗效的影响。方法:回顾性分析2002年1月至2010年12月本中心初诊170例APL患者的临床和预后特点。结果:170例初诊APL患者中,24例存在FLT3-ITD突变,阳性率14.1%,其中3例合并FLT3-TKD突变。FLT3-ITD+组患者发病时白细胞计数显著高于阴性组,高危组FLT3-ITD突变发生率最高。FLT3-ITD+组与阴性组的诱导死亡率分别为12.5%和2.9%(P=0.031),其诱导完全缓解(CR)率分别为83.3%和97.1%(P=0.004)。FLT3-ITD+组5年总生存率(OS)为87.5±6.8%,阴性组为90.6±2.6%(P=0.740),5年无病生存率(DFS)两组分别为82.8±9.1%和83.6±3.4%(P=0.928)。结论:FLT3-ITD突变与APL高白细胞数相关。伴FLT3-ITD突变APL诱导治疗死亡率高,CR率低,但FLT3-ITD突变对于APL长期DFS及OS无显著影响。

《2013年全球乳房健康共识指南》解读--医院-社区一体化的延续性护理在乳腺癌生存者照护中的重要作用

乳腺癌发病率在中国呈快速上升趋势,同时其又是可以治愈的疾病,带癌生存者逐年增多;因此,医院-社区一体化的延续性护理势在必行。本文对《2013年全球乳房健康共识指南——中、低等收入国家乳腺癌生存者治疗期后的支持性护理》的内容进行解读,思考医院-社区一体化延续性护理的优势与提供者,介绍指南中专家根据资源分配情况建议相应的护理措施,并且分析我国目前开展医院-社区一体化延续性护理的障碍,旨在为我国护理工作者进行乳腺癌延续性护理提供科学依据。

HER-2阳性乳腺癌患者新辅助化疗联合曲妥珠单抗治疗的影响因素及预后分析

目的:探讨人类表皮生长因子受体(human epidermal growth factor receptor 2,HER-2)阳性乳腺癌患者应用新辅助化疗联合曲妥珠单抗的疗效及其预后的影响因素。方法:选取2014年01月01日至2018年12月31日郑州市第三人民医院乳腺甲状腺外科收治经穿刺病理证实为乳腺癌的患者151例,免疫组化结果均显示为HER-2阳性,并行新辅助化疗,根据患者经济条件及意愿选择是否接受曲妥珠单抗治疗,将其分为单纯新辅助化疗组(neoadjuvant chemotherapy,NAC)94例,新辅助化疗联合曲妥珠单抗组(NAC+H)57例,对比两组患者无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)情况,并分析影响预后的相关因素。结果:151例HER-2阳性乳腺癌患者中,NAC+H组患者DFS(P=0.046)和OS(P=0.026)均明显优于NAC组,两组比较差异具有统计学意义。术前淋巴结状态、术后淋巴结状态、肿瘤大小、MP分级是影响患者DFS和OS的主要影响因素(P值分别为0.032、0.018、0.038、0.010)。结论:接受新辅助化疗联合曲妥珠单抗的HER-2阳性乳腺癌患者预后较好,两组在新辅助治疗后肿瘤大小、淋巴结状态及MP分级结果存在明显差异,该结果对选择合理的治疗方案、判断预后有重要作用。

乳腺癌组织中ABCG2和HIF-1α的表达及临床意义

目的探讨乳腺癌耐药相关蛋白(ABCG2)、缺氧诱导因子1α(HIF-1α)蛋白的表达与乳腺癌病理特征及预后之间的关系。方法选取122例接受乳腺癌手术治疗患者的乳腺癌组织石蜡标本,用免疫组化SP法检测ABCG2、HIF-1α蛋白的表达情况。结果122例乳腺癌组织ABCG2、HIF-1α的阳性表达率分别为40.2%和59.0%。ABCG2表达与肿块大小呈正相关(P=0.018);HIF-1α表达与肿块大小(P<0.01)、淋巴结转移(P<0.01)、临床分期呈正相关(P=0.022)。ABCG2表达与122例患者的无病生存期有负相关趋势,无统计学意义(P=0.052),与106例接受了以蒽环类化疗药为主的辅助化疗患者的无病生存期呈负相关(P=0.033)。HIF-1α表达与122例患者的无病生存期呈负相关(P=0.030)。HIF-1α和ABCG2共表达与122例患者的无病生存期呈负相关,有明显统计学意义(P=0.004)。结论ABCG2表达阳性是接受以蒽环类化疗药为主的辅助化疗的乳腺癌患者的预后不良指标。HIF-1α与ABCG2表达明显相关。HIF-1α与ABCG2共检验可以更好的判断乳腺癌患者预后。

子宫内膜癌PR、ER、PTEN、p53及Ki-67的表达情况及其与预后的相关性分析

目的探讨子宫内膜癌孕激素受体(PR)、雌激素受体(ER)、磷酸酶与张力蛋白同源物(PTEN)、p53及Ki-67与临床病理特征和预后的相关性。方法选取2008年7月—2009年1月收治的子宫内膜癌198例,收集患者临床、病理及术后随访等资料,对PR、ER、PTEN、p53及Ki-67与临床病理特征的关系和对预后的影响进行相关性分析。结果 ER阳性表达率在病理分型、FIGO分级、组织病理学分期、肌层浸润程度中比较差异有统计学意义(P<0.05);不同病理分型、组织病理学分期中PR阳性表达率比较差异有统计学意义(P<0.05);p53阳性表达率随组织病理分级越高表达水平越高,与病理分型有关(P<0.05);Ki-67随着组织病理学分级越高表达水平越高(P<0.05)。FIGO分级Ⅲ~Ⅳ期、有淋巴结转移、PR阴性表达是影响子宫内膜癌患者预后生存的危险因素(P<0.01)。结论 PR表达水平与子宫内膜癌患者预后密切相关。

乳腺癌中survivin表达的预后价值

目的:研究凋亡抑制基因survivin在乳腺癌中表达的预后价值。方法:采用免疫组化SP法检测180例乳腺癌石蜡标本中survivin表达情况,并对survivin表达与乳腺癌的临床分期、雌激素受体表达、月经状况、腋淋巴结转移、病理类型、无病生存时间以及总生存时间的关系进行了分析。结果:Survivin在乳腺癌中的阳性表达率为66.1%,survivin的表达与乳腺癌的临床分期、雌激素受体、月经状况、腋淋巴结是否转移及病理类型无关(P>0.05);单因素分析结果表明survivin表达与乳腺癌病人的无病生存时间和总生存时间显著相关,survivin表达阳性病人的无病生存时间和总生存时间均显著低于survivin表达阴性的病人;多因素Cox回归分析结果表明survivin的表达状况是决定乳腺癌病人无病生存时间的独立因素,而与总生存时间无关。结论:Survivin是判断乳腺癌预后的一个独立生物学指标,阳性表达病人的预后较阴性表达病人差。

结直肠癌术后放化疗联合DC-CIK的疗效分析

目的探讨放化疗联合树突细胞-细胞因子诱导的杀伤细胞(DC-CIK)对结直肠癌的疗效。方法回顾性分析51例结直肠癌根治术后行放化疗联合HPS70(Heat Shock Protain70)负载的DC-CIK细胞疗法患者的临床资料,采用1∶1配对的方法 ,以性别、年龄、部位、病理分期、AJCC(1997)中临床分期、术后辅助化疗方案、是否接受术后辅助放疗为指标,在同期行结直肠癌根治术但未行DC-CIK细胞疗法的患者中选择51例作为对照,比较两组患者3年生存率(OS)和3年无病生存率(DFS)。结果 DC-CIK治疗组及对照组3年生存率分别为88.2%和68.6%,两者比较差异具有显著性(P<0.05)。DC-CIK治疗组及对照组3年无病生存率分别为43.1%和27.5%,两者比较差异具有显著性(P<0.05)。结论结直肠癌根治术后放化疗联合DC-CIK细胞疗法,能明显提高患者的远期生存率和无病生存率。

乳腺癌复发转移前后激素受体、HER-2表达的改变及其临床意义

目的探讨乳腺癌原发灶与复发转移灶中激素受体及HER-2表达的改变及分子表型改变与临床特征的关系。方法本研究纳入解放军总医院1999年4月1日-2013年8月31日收治的175例术后出现复发转移并再次行病理活检的乳腺癌患者,所有病例均有完整病历资料及初诊与复发转移后的病理检测资料,全部175例均进行了雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)表达检测,其中128例患者具有复发转移前后的Her-2表达检测。结果乳腺癌出现复发转移后ER、PR、Her-2与初诊时不一致的比例分别为35.4%(Mc Nemar检验P=0.003)、39.4%(P=0.030)、14.8%(P=0.001)。复发转移后ER、PR的阳转率分别为10.9%、14.3%,阴转率分别为24.6%、25.1%,阴转率均高于阳转率(PER=0.003,PPR=0.030)。Her-2的阳转率为13.3%,阴转率为1.6%,阳转率高于阴转率(P=0.001)。乳腺癌患者复发转移前后,ER、Her-2的表达是否发生改变与初诊时肿瘤大小相关(PER=0.010,PHer-2=0.042);复发转移前后不同分子表型组间DFS呈现一定的趋势。结论乳腺癌的异质性与肿瘤大小相关,复发转移后的分子表型会发生改变,分子表型的改变与无病生存时间可能有关。乳腺癌出现复发转移后,肿瘤的恶性程度有升高的趋势。