不同分子亚型乳腺癌首发骨转移患者的临床特征和预后分析#br# #br#

摘要：目的　探究不同分子亚型乳腺癌首发骨转移患者的临床特征及预后。方法 收集167例乳腺癌首发骨转移患者的临床资料。依据雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体-2（HER-2）、Ki-67的表达情况，分为Luminal A型、Luminal B型、HER-2过表达型和三阴性型（TNBC）4个分子亚型。分析4种亚型患者临床及预后特征的差异。结果 167例患者中Luminal A型24例（14.37%），Luminal B型102例（61.08%），HER-2过表达型18例（10.78%），TNBC型23例（13.77%）。4种亚型均以浸润性导管癌为主；pTNM分期中Luminal A型以Ⅰ期为主，其他3型以Ⅱ~Ⅲ期为主。手术方式中Luminal B型主要采用根治术，其他3型则以仿根治术为主。4种亚型患者月经状态、淋巴结转移、骨转移时碱性磷酸酶（ALP）水平和乳腺癌肿瘤标志物水平、其他远处转移情况、骨相关事件（SREs）、药物治疗模式等差异均无统计学意义。4种亚型的中位无转移时间分别为53、34、15、33个月（Log-rank χ2=10.592，P＜0.05）；中位总生存时间分别为90、116、63、61个月（Log-rank χ2=13.080，P＜0.01）；骨转移后中位生存时间分别为35、48、23、18个月（Log-rank χ2=15.590，P＜0.01）。HER-2过表达型中位无转移时间最短，其次为TNBC型和Luminal B型，Luminal A型最长。TNBC型患者总生存时间最短，其次为HER-2过表达型和Luminal A型，Luminal B型最长。分子亚型、pTNM分期、靶向治疗、SREs、CA153水平是患者总生存时间的独立影响因素（P＜0.05）。HER-2过表达型和TNBC型的死亡风险分别是Luminal A型的2.799、2.306倍，Luminal B型的死亡风险比 Luminal A型下降了62%。结论　4种分子亚型的乳腺癌首发骨转移患者中，HER-2过表达型和TNBC型患者预后较差；HER-2过表达型最早出现骨转移。

Analysis of clinical features and prognosis of patients with first-episode bone metastasis of different molecular subtypes of breast cancer

Abstract: Objective To explore the clinical characteristics and prognosis of patients with different molecularsubtypes of breast cancer with first-episode bone metastases. Methods　The clinical data of 167 patients with first-episode bone metastasis of breast cancer were collected. According to the expression levels of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2) and ki-67, patients were divided into Luminal A, Luminal B and HER-2 overexpression types and triple negative (TNBC) molecular subtypes. The clinical and prognostic characteristics of the four subtypes were analyzed. Results Among the 167 patients, 24 (14.37%) had Luminal A subtype, 102 (61.08%) had Luminal B subtype, 18 (10.78%) had overexpression HER-2 subtype and 23 (13.77%) TNBC subtype. The four subtypes were mostly invasive ductal carcinoma. In the pTNM staging, Luminal A was mainly stage I, and the other three types were mainly stage II-III. Luminal B is usually treated by radical mastectomy, and the other three types were usually treated by imitate radical surgery. There were no significant differences in menstrual status, lymph node metastasis, alkaline phosphatase (ALP) levels and breast cancer tumor marker levels, other distant metastases, skeletal-related events (SREs) and drug treatment modes between patients with four subtypes (P＞0.05). The median metastasis-free time of the four subtypes were 53, 34, 15 and 33 months, respectively (Log-rank χ2=10.592, P＜0.05). The median overall survival time was 90, 116, 63 and 61 months, respectively (Log-rank χ2=13.080, P＜0.01). The median survival time after bone metastasis was 35, 48, 23 and 18 months, respectively (Log-rank χ2=15.590, P＜0.01). The median metastasis-free time of patients with HER-2 overexpression was the shortest, followed by TNBC and Luminal B, and Luminal A was the longest. TNBC patients had the shortest overall survival time, followed by HER-2 overexpression and Luminal A, and Luminal B was the longest. Molecular subtypes, pTNM, targeted therapy, SREs and CA153 levels were independent factors influencing overall survival time in patients with first-episode bone metastasis of breast cancer (P＜0.05). The death risk in patients with HER-2 overexpression and TNBC subtype were 2.799 and 2.306 times higher than that of Luminal A subtype. However, Luminal B had a 62% lower risk death than Luminal A. Conclusion　Among the four molecular subtypes of breast cancer patients, patients with HER-2 overexpression and TNBC have poor prognosis. HER-2 overexpression is the first to have bone metastasis.