Oncol2012: 乳腺癌临床病理分型与个体化治疗

目的 探讨乳腺癌临床病理分型在浸润性乳腺癌个体化治疗中的价值。方法 对2010年1月至12月北京大学第一医院乳腺疾病中心收治的浸润性乳腺癌病人进行回顾性分析。依据2011年St.Gallen乳腺癌分型标准，复检其雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)及Ki-67表达水平，将乳腺癌分为Luminal A、Luminal B、HER-2阳性和三阴型四个亚型，并分析各亚型与TNM分期、病理组织分级的关系。结果 共213例浸润性乳腺癌病人入组，其中Luminal A型53例(24.9％)，Luminal B型112例(52.6％)，HER-2阳性型22例(10.3％)，三阴型26例(12.2％)。Luminal A型病人中病理组织学分级I级39例，占同型病人73.6% (39/53)，III级病人0例；Luminal B型病人中I级24例，占同型病人21.4%（24/112），III级25例，占同型病人22.3%（25/112）；三阴型病人中I级2例，占同型病人7.7%（2/26），III级17例，占同型病人65.4%（17/26）；HER-2阳性型病人I级仅1例，占同型病人4.5%（1/22），III级11例，占同型病人50.0%（11/22）。各亚型间病理组织分级存在差异（P﹤0.001）。分析各亚型TNM分期发现，Luminal A型病人I期比例最高，占同型病人54.7%（29/53）。HER-2阳性型III期病例比例最高，占同型病例27.3%（6/22）。不同亚型TNM分期分布具有差异性（P﹤0.001）。结论 不同亚型乳腺癌其病理组织分级及TNM分期具有差异性， 在TNM分期及病理组织分级基础上联合临床病理分型分析是个体化治疗的重要内容。

Clinicopathological classification and individualized treatment of breast cancerHu Hui1, Liu Yinhua1, Xu Ling1, Zhao Jianxin1, Duan Xuening1, a Ye Jingming1, Li Ting2, Zhang Hong2, Zhang Shuang2, Xiong Yan2

Purpose To investigate the value of clinicopathological classification and other clinicopathological parameters in the treatment strategies of invasive breast cancermethods A retrospective analysis of breast cancer subtype, tumor-node-metastasis (TNM) stage, and histopathological grade of 213 cases has been performed by the methods recommended in the St. Gallen International Expert Consensus report 2011. The estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 of 213 tumor samples have been investigated by immunohistochemistry according to methods for classifying breast cancer subtypes proposed in the St. Gallen consensus report 2011. Results The luminal A subtype was found in 53 patients (24.9%), the luminal B subtype was found in 112 patients (52.6%), the HER2-positive subtype was found in 22 patients (10.3%), and the triple-negative subtype was found in 26 patients (12.%). Histopathological grade and TNM stage differed significantly among the four subtypes of breast cancer (p < 0.001).Conclusions It is important to consider TNM stage and histopathological grading in the treatment strategies of breast cancer based on current clinicopathogical classification methods.