可手术的不同分子亚型乳腺癌的临床特征和生存分析

目的 分析Luminal A型、Luminal B型、人表皮生长因子受体2(HER-2)型和Basal-like型4种乳腺癌亚型的临床特征和生存状况,探讨乳腺癌个体化综合治疗的理论基础.方法 回顾性分析经手术治疗、资料完整、免疫组化方法能明确判定受体状况的乳腺癌患者408例,比较各型乳腺癌的临床特征、复发转移及生存情况.结果 Luminal A型248例,占60.8%;Luminal B型32例,占7.8%;HER-2型51例,占12.5%;Basal-like型77例,占18.9%.HER-2型乳腺癌≤45岁者明显少于其他亚型,Basal-like型乳腺痛发生腋窝淋巴结转移者的比例低于其他亚型,Luminal B型晚期病例多于其他亚型,而HER-2型早期病例多于其他亚型.获得随访的243例患者中,复发或转移58例,死亡51例.Luminal A型的复发转移率明显低于Luminal B型和Basal-like型(均P<0.05).Luminal A型、Luminal B型、HER-2型和Basal-like型的5年生存率分别为89.83%、86.15%、86.70%和79.85%,Luminal A型高于Basal-like型(P=0.008).Luminal A型、Luminal B型、HER-2型和Basal-like型的5年无病生存率分别为83.52%、68.88%、75.83%和71.66%,Luminal A型高于Luminal B型和Basal-like型(P=0.0481和P=0.0306).结论 中国人各亚型乳腺癌的构成比与欧美国家接近,Luminal A型是最常见的乳腺癌亚型,预后较好,Basal-like型和Luminal B型所占比例较小,但预后较差.

Clinical characteristics and survival in the operable breast cancer patients with different molecular subtypes

Objective According to the immunohistoehemieal (IHC) test of ER, PR and HER-2, breast cancer can be divided into 4 different molecular subtypes : Luminal A subtype ( ER or PR positive and HER-2 negative) , Luminal B subtype (ER or PR positive and HER-2 positive) , HER-2 subtype (ER and PR negative, HER-2 positive) and Basal-like subtype ( ER, PR and HER-2 negative). This study was to analyze the clinical features of different breast cancer subtypes, and try to find the evidence of combined and individualized treatment for patients with breast cancer. Methods The data of 408 surgically treated breast cancer patients in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1, 2002 to December 31, 2002 were collected and retrospectively analyzed. The elinicopathological features and recurrence, metastasis as well as survival of these four subtypes were compared. Results Of the 408 cases, Luminal A subtype accounted for 60. 8% ( 248/408 ), Luminal B subtype 7.8% ( 32/408 ), HER-2 subtype 12.5% (51/408), and Basal-like subtype 18.9% (77/408). Basal-like subtype had less lymph node metastases than other subtypes ( P < 0. 05 ). HER-2 subtypes consisted of less patients aged 45 years or younger than other subtypes ( P < 0. 05 ). Luminal B subtype contained less advanced cases than other subtypes ( P < 0.01 ). By August 2008, the median time of follow-up was 64 months ( range, 3-79 months). Fifty-eight cases presented local recurrence or metastasis, and 51 of them died of the disease. The 5-year overall survival rates (OS) for patients with luminal A, Luminal B, Basal-like and HER-2 subtype were 89.83%, 86.15%, 79.85% and 86.70%, respectively. The 5-year disease-free survival (DFS) rates of the four subtypes were 83. 52%, 68. 88%, 71.66% and 75. 83%, respectively. The rate of local recurrence or metastasis in luminal A subtype was significantly lower than that in Luminal B and Basal-like subtypes(P <0.05). The DIS time in Luminal B subtype was shorter than that in Luminal A subtype(P= 0.0481 ). The OS and DIS time in Basal-like subtype were all shorter than that in Luminal A subtype( P =0. 0077 and P = 0. 0306, respectively). Conclusion The distribution of each subtype in Chinese breast cancer patients is similar to that in European and American breast cancer patients. Luminal A is the most common subtype in Chinese breast cancer patients, and has a good prognosis. While Basal-like and Luminal B subtype have a poor prognosis.