雄激素受体在Her-2过表达型乳腺癌中的意义

摘 要：［目的］ 探讨雄激素受体（androgen receptor,AR）在人表皮生长因子受体-2（human epidermal growth factor receptor-2,Her-2）过表达型乳腺癌中的临床意义。［方法］ 用免疫组化方法检测有完整临床及随访资料的102例Her-2过表达型乳腺癌中AR表达,并分析其与临床病理特征及5年无疾病进展时间（disease-free survinal,DFS)的相关性。［结果］ AR在Her-2过表达型乳腺癌阳性率为75.5%（77/102）;淋巴结阴性组AR表达率为84.91%（45/53）,明显高于淋巴结阳性组的65.31%（32/49）(χ2=5.286,P=0.021);Ki-67阴性组AR表达率（89.47%,34/38）明显高于Ki-67阳性组的67.19%（43/64）(χ2=6.400,P=0.011）。生存分析显示,AR阳性组5年无瘤生存率为71.7%,明显低于AR阴性组的89.8%(χ2=5.736,P=0.017）。Cox回归分析显示,AR是影响Her-2过表达型乳腺癌5年DFS的独立预后因素（RR=3.961,95%CI：1.008~15.574）。［结论］ AR在Her-2过表达型乳腺癌中的表达率高,AR阳性患者预后较差,AR可能成为Her-2过表达型乳腺癌新的治疗靶点。     

双侧原发性乳腺癌的预后影响因素分析

目的 :研究双侧原发性乳腺癌的预后及其影响因素。方法 :对经病理证实的 30例双侧原发性乳腺癌患者进行分析。结果 :腋淋巴结无转移患者的 5年生存率 ( 64 7% )明显高于腋淋巴结转移的患者 ( 30 8% )。肿瘤直径 <2cm的患者 5年生存率 ( 62 5% )明显高于肿瘤直径≥ 2cm的患者 ( 4 5 5% )。ER受体阳性患者的 5年生存率 ( 66 7% )明显高于ER受体阴性患者 ( 38 9% )。结论 :双侧原发性乳腺癌的预后取决于腋窝淋巴结有无转移 ,肿瘤大小以及ER受体是否阳性。其中腋淋巴结有无转移是影响预后的一个重要指标。     

激素受体和人表皮生长因子受体2的表达与改良根治术后淋巴结阳性乳腺癌患者预后的关系

目的 探讨雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(Her-2)的表达情况与行改良根治术后腋窝淋巴结阳性乳腺癌患者预后的关系.方法 收集835例行改良根治术后腋窝淋巴结阳性乳腺癌患者的临床和随访资料.根据ER、PR和Her-2的免疫组化检查结果,将患者分为Rec-/Her-2-(三阴性)组、Rec-/Her-2+组、Rec+/Her-2+组和Rec+/Her-2-组,比较其局部区域复发率、远处转移率、无瘤生存率和总生存率.结果 835例患者中,三阴性组141例,Rec-/Her-2+组99例,Rec+/Her-2+组157例,Rec+/Her-2-组438例.Rec+/Her-2-患者的5年局部区域复发率为6.2%,低于其他患者(12.9%,P=0.004).与受体阳性组(Rec+/Her-2+和Rec+/Her-2-)比较,受体阴性组(Rec-/Her-2-和Rec-/Her-2+)有较高的5年远处转移率(26.4%和19.7%,P=0.0008)、较低的5年无瘤生存率(66.7%和75.6%,P=0.0001)和较低的5年总生存率(71.4%和84.2%.P=0.0000).多因素Cox回归分析结果显示,激素受体和Her-2的表达状态是乳腺癌患者局部区域复发、远处转移、无瘤生存和总生存的独立影响因素(均P<0.05),Rec+/Her-2-患者的局部区域复发风险低,受体阴性患者发生远处转移和死亡的风险高.结论 ER、PR和Her-2是改良根治术后腋窝淋巴结阳性乳腺癌患者的独立预后因素.     

不同激素受体状态乳腺癌趋化因子CCL5的表达及临床意义

目的探讨不同激素受体状态乳腺癌组织中趋化因子CCL5表达的临床意义。方法应用免疫组织化学SP法检测2008年1月至2010年1月芜湖市第二人民医院121例浸润性乳腺癌手术患者组织石蜡样本中CCL5的表达,采用χ2检验分析CCL5与临床病理因素关系,并运用单因素和多因素生存分析不同激素受体状态乳腺癌组织中CCL5表达的预测价值。结果乳腺癌组织中CCL5表达与淋巴结状态有关(χ~2=18.676,P0.001)。CCL5阳性组的5年DFS显著低于CCL5阴性组(χ~2=5.089,P=0.024),淋巴结状态阳性组的5-DFS显著低于淋巴结状态阴性组(χ~2=26.105,P0.001)。进一步多因素分析显示,淋巴结状态是乳腺癌患者5年DFS的独立预后因素(RR=5.453,95%CI:2.589~11.485,P0.001)。激素受体阳性患者中,CCL5阳性组的5年DFS显著低于CCL5阴性组(χ2=10.535,P=0.001),淋巴结状态阳性组的5年DFS显著低于淋巴结状态阴性组(χ~2=11.439,P=0.001),不同组织学分级组患者间5年DFS差异具有统计学意义(χ~2=6.024,P=0.049),进一步多因素分析显示,CCL5是激素受体阳性乳腺癌患者5年DFS的独立预后因素(RR=3.205,95%CI:1.052~9.762,P=0.040),淋巴结状态是激素受体阳性乳腺癌患者5年DFS的独立预后因素(RR=3.915,95%CI:1.191~12.872,P=0.025)。结论不同激素受体状态乳腺癌组织中CCL5的表达,能为乳腺癌内分泌治疗提供更准确诊疗依据。     

如何优化三阳性乳腺癌的临床治疗方案

激素受体(HR)和人表皮生长因子受体2(Her-2)是影响乳腺癌患者预后的两个重要生物学指标,通常两者在乳腺癌组织中不同时表达.大量的研究显示,HR阴性或Her-2扩增或过表达(简称Her-2高表达)的乳腺癌,组织分化程度低,对内分泌治疗效果差,患者的无病生存期(DFS)和总生存期(OS)均较短.     

凋亡相关基因Fas-1377和Fas-670基因多态对乳腺癌预后的影响

目的 探讨Fas-1377和Fas-670基因的多态性与中国女性乳腺癌患者预后之间的关系.方法 采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,检测310例中位随访时间达10.5年的原发性乳腺癌患者Fas-1377和Fas-670基因的多态性,分析其与乳腺癌预后的关系.结果 Fas-1377和Fas-670基因的多态性与全组乳腺癌患者的预后无显著的相关性(P>0.05).在腋淋巴结阴性的患者中,Fas-1377基因多态性与乳腺癌患者的预后显著相关,AA纯合突变型患者的5年总生存率(OS)显著低于GA和GG基因型者(66.7%:95.4%,P=0.03);而Fas-670基因多态性与腋淋巴结阴性患者的预后无显著的相关性(P>0.05).在腋淋巴结阳性的患者中,Fas-1377和Fas-670基因的多态性与患者的5年OS均无显著的相关性(均P>0.05).结论 在腋淋巴结阴性的乳腺癌患者中,Fas-1377基因多态具有潜在的预后价值,携带Fas-1377 AA基因型的乳腺癌患者预后不良.     

乳腺癌组织EG-1和Her-2表达及其与预后关系的探讨

目的:探讨乳腺癌组织中EG-1和Her-2的表达及其与乳腺癌临床特征、预后的相关性.方法:采用 RT-PCR技术检测EG-1在 72 例乳腺癌及 18 例良性乳腺组织中的表达,应用免疫组化技术检测分析Her-2的表达.结果:乳腺癌组织EG-1 mRNA表达(71%)显著高于良性乳腺组织(24%),χ2=17.604,P<0.01.淋巴结转移数目越多,EG-1 mRNA阳性率越高,P<0.05.51例EG-1 mRNA阳性患者中,33例(64.7%)发生复发转移;而21例EG-1 mRNA阴性患者中,仅5例(23.8%)发生复发转移,差异有统计学意义,χ2=9.982,P<0.05.单因素生存分析表明,EG-1表达不同的患者间总生存时间(OS)和无病生存时间(DFS)差异均有统计学意义,P<0.05.Cox模型多因素回归分析显示,淋巴结转移数、EG-1 mRNA、Her-2蛋白是预测总生存率和无复发生存率的独立预后因素.结论: EG-1基因在乳腺癌组织中异常高表达,且与淋巴结转移相关,是乳腺癌潜在的预后标志.     

三阴性乳腺癌与人表皮生长因子受体2过表达乳腺癌患者的临床病理特征和预后比较

目的 研究三阴性乳腺癌和人表皮生长因子受体2(Her-2)过表达乳腺癌患者的临床病理学特征以及无病生存期.方法 对1998至2003年间在上海长海医院确诊的770例乳腺癌患者进行回顾性分析,确立三阴性乳腺癌表型,并且与Her-2过表达乳腺癌进行比较,分析两组患者p53和上皮性钙黏蛋白(E-cadherin)状态以及发病年龄、肿瘤直径、肿瘤部位、组织学类型、分级、淋巴结转移状态、AJCC分期、是否化疗和手术方式之间的差异.对影响两组患者尤病生存率的相关因素进行分析.结果 770例患者中,三阴性乳腺癌96例,占12.5%;Her-2过表达乳腺癌164例,占21.3%.三阴性乳腺癌和Her-2过表达乳腺癌的p53和E-cadherin状态的差异均无统计学意义(均P>0.05).三阴性乳腺癌(71.9%)较Her-2过表达乳腺癌(58.5%)更容易发生淋巴结转移(P=0.034),并且三阴性乳腺癌中淋巴结转移≥10枚患者所占的比例(26.0%)明显大于Her-2过表达乳腺癌(12.2%,P=0.034).三阴性乳腺癌中组织学分级为3级的患者比例(67.7%)明显高于Her-2过表达乳腺癌(42.1%,P<0.0001).三阴性乳腺癌的肿瘤直径与淋巴结转移状态有关(P=0.024).三阴性乳腺癌和Her-2过表达乳腺癌的局部复发率和远处转移率的差异虽无统计学意义(P>0.05),但三阴性乳腺癌的无病生存期(61.85个月)明显短于Her-2过表达乳腺癌(78.69个月,P=0.047).结论 与Her-2过表达乳腺癌比较,三阴性乳腺癌的侵袭性更强,患者的无病生存期更短,预后更差.     

81例乳腺癌PTEN表达及与预后关系

[目的]探索PTEN在乳腺癌组织不同临床病理参数下的表达及与预后关系。[方法]对1989全年81例乳腺癌病例,应用免疫组化SP法检测乳腺癌组织中PTEN的表达,对不同临床病理参数下的表达及对术后5年、10年和15年生存率的影响进行分析。[结果]PTEN表达的阴性率为33.33%(27/81),阳性率为66.67%(54/81)。Her-2/neu阳性表达标本中PTEN阳性表达率为47.23%,Her-2/neu阴性表达标本中PTEN阳性表达率为82.22%,Her-2/neu阴阳性之间的PTEN表达有显著性差异(P<0.01);而其它如绝经状态、肿块大小、病理类型、腋淋巴结和ER状态之间的PTEN表达无显著性差异。PTEN阴性表达患者的5年、10年的生存率显著低于PTEN阳性表达的患者。[结论]PTEN失表达提示乳腺癌术后生存时间较短。PTEN可以作为分子标记物辅助临床判断乳腺癌的预后。     

热休克蛋白70在乳腺癌中的表达及其与预后的关系

目的 探讨热休克蛋白70(heat shock protein70，HSP70)在乳腺癌中的表达，评估其在乳腺癌预后中的作用。方法 用免疫组化方法检测62例手术切除的乳腺癌组织中HSP70的表达，研究其与临床病理特征的关系及对预后的影响。结果 (1)HSP70在乳腺癌组织中的阳性表达率为56．5％(35／62)。(2)HSP70表达与肿瘤大小(P=0．021)及腋窝淋巴结转移(P=0．015)存在相关性，而与月经状况、组织学分级之间均无相关性。(3)HSP70阴性表达组的无病生存期(DFS)及总生存期(OS)均明显优于阳性表达组。(4)(20x回归单因素分析显示腋窝淋巴结转移个数、组织学分级、肿瘤大小、TNM分期及HSP70阳性表达与DFS及OS明显相关；Cox回归多因素分析表明仅有腋窝淋巴结转移个数、组织学分级及肿瘤大小与DFS及OS明显相关，而TNM分期及HSP70阳性表达进入Cox回归模型。结论 HSP70在乳腺癌组织中有一定程度的表达，HSP70阳性表达与乳腺癌患者生存期的缩短有关，由于多因素回归分析未能显示HSP70表达与DFS和OS相关，因此HSP70不能作为乳腺癌的独立的预后因素。     

Prognosis of a series of 763 consecutive node-negative invasive breast cancer patients without adjuvant therapy: analysis of clinicopathological prognostic factor.

BACKGROUND AND OBJECTIVES: The objectives of this study were to confirm the favorable outcome of Japanese invasive breast cancer patients without lymph node metastasis, after treatment with surgery alone, and to evaluate clinicopathological prognostic factors in this population. METHODS: The subjects were 763 consecutive node-negative invasive breast cancer patients who underwent surgery without adjuvant therapies between 1988 and 1993 at our hospital. Disease-free survival (DFS) and overall survival (OS) rates were analyzed by clinicopathological factors. RESULTS: The median age of the patients at surgery was 52 years and the median follow-up period of patients was 74 months. At 5 years, the respective DFS and OS rates of all patients were 90.8% and 93.9%. Patients with a pathological tumor size of invasive component of more than 2 cm (319 patients) had a significantly lower DFS than those with tumors measuring 2 cm or less (361 patients) (P = 0.045). Patients with positive hormone receptor status (280 patients) (estrogen and/or progesterone receptor positive) tended to have a better OS than those negative for both hormone receptors (92 patients) (P = 0.078). Meanwhile, patients with tumors of histological grade 3 (328 patients) had a much poorer prognosis than those with tumors of histological grade 1 or 2 (413 patients) (P = 0.008 for OS and P = 0.042 for DFS). The respective 5-year DFS and OS rates of patients with histological grade 3 tumors larger than 2 cm in pathological tumor size of invasive component (195 patients) were 85.5% and 87.6%, indicating that these node-negative patients form a high risk group. CONCLUSIONS: Japanese invasive breast cancer patients without lymph node metastasis tended to show a survival advantage compared with their Caucasian counterparts. Histological grade was the most useful prognostic factor in this population.     

A combination of HER-2 status and the St. Gallen classification provides useful information on prognosis in lymph node-negative breast carcinoma

BACKGROUND: Adjuvant chemotherapy for patients with lymph node-negative breast carcinoma is being recommended currently based on the St. Gallen classification. The prognostic importance of HER-2 status in patients with lymph node-negative breast carcinoma has been investigated extensively, with contradictory results. The authors investigated the clinical relevance of HER-2 overexpression when combined with the St. Gallen classification in lymph node-negative breast carcinoma. METHODS: The medical records of patients with breast carcinoma negative for lymph node involvement who underwent surgery between January 1995 and December 2000 at the Seoul National University College of Medicine (Seoul, Korea) were reviewed retrospectively. Risk groups based on the St. Gallen classification were categorized as average or minimal risk. The prognostic values of HER-2 in combination with the St. Gallen classification were analyzed with respect to disease-free survival (DFS) rates. RESULTS: A total of 906 patients were eligible for analysis. The overall 7-year DFS rate was 87.5%. The 7-year DFS rates for patients with HER-2-positive and HER-2-negative tumors were, respectively, 77.9% and 91.2% (P = 0.002). The 7-year DFS rates for patients with average and minimal risk group were 85.0% and 97.9%, respectively. The authors found that HER-2 overexpression significantly predicted the risk of disease recurrence (odds ratio = 3.03 [95% confidence interval, 1.63-5.63]). Furthermore, when HER-2 status was combined with the St. Gallen classification, the DFS rate of the HER-2-positive average risk group was 73.3% compared with 88.4% for the HER-2-negative average risk group (P = 0.007). CONCLUSIONS: The combination of HER-2 overexpression and the St. Gallen classification was more useful than either alone to predict the risk of disease recurrence in patients with lymph node-negative breast carcinoma.     

Immunoenzymatically determined pepsinogen C concentration in breast tumor cytosols: an independent favorable prognostic factor in node-positive patients.

The aim of this study was to determine the concentration and to evaluate the prognostic value of pepsinogen C (PepC) in breast cancer patients. PepC is an aspartic proteinase that is involved in the digestion of proteins in the stomach and is also synthesized by a subset of human breast tumors. PepC concentrations were measured with a highly sensitive immunofluorometric assay, which uses two monoclonal antibodies that are specific for PepC and has a detection limit of 0.1 ng/ml. Breast tumor cytosols from 151 patients (median follow-up, 67 months), stratified according to nodal status, were evaluated. An optimal cutoff value, equal to 1.75 ng/mg of extracted protein, was first defined by statistical analysis. PepC status was then compared with other established prognostic factors, in terms of disease-free survival (DFS) and overall survival (OS). High PepC concentrations were found in small (P = 0.003) and well-differentiated tumors (P = 0.042) as well as in stage I (P = 0.003) and node-negative patients (P = 0.040). Statistically significant associations of PepC concentration with patient age and estrogen receptor and progesterone receptor status were not observed. In univariate Cox regression analysis of the entire cohort of patients, negative PepC proved to be a significant predictor of reduced DFS (P = 0.0086) and OS (P = 0.025). Multivariate analysis in subgroups of patients defined by nodal status indicated that PepC status was a strong predictor of DFS (P = 0.0039) and the strongest factor for predicting OS (P = 0.0046) in node-positive but not in node-negative patients. Our results suggest that PepC may be used as an independent favorable prognostic factor in node-positive breast cancer patients because there were no significant associations between PepC and the other prognostic factors evaluated in this group of patients.     

Predictive value of c-erbB-2 and cathepsin-D for Greek breast cancer patients using univariate and multivariate analysis.

The value of various prognostic factors in breast cancer patients has been determined in a number of studies. One hundred thirty-eight Greek women were followed up over a 5-year period after surgery for breast cancer. Amplification and overexpression of c-erbB-2 was found in 22.4% and 29.7% of the respective cases, and the concentration of total cytosolic Cathepsin-D (CD) in 46.4% of them was high (> or = 60 pmol/mg protein). The examined biological variables were compared with standard clinicopathological prognostic factors for the disease and related to early relapse (ER; before 3 years), relapse-free survival (RFS; median, 5 years), and overall survival (OS; median, 5 years). It was found that high CD levels significantly shorten ER of both node-negative and node-positive patients (P < 0.0001 and P = 0.002, respectively) and have prognostic value for RFS and OS of node-negative patients (P = 0.0012 and P = 0.0288, respectively), but lose their value as relapse predictors for node-positive patients for periods longer than 3 years. Overexpression of c-erbB-2 was found to be predictive for OS of node-positive and -negative patients (P = 0.0048 and P = 0.0285, respectively), but its predictive power was weak for ER (P = 0.0456) and RFS (P = 0.0455) of node-negative patients and disappeared for node-positive patients. c-erbB-2 amplification offers minimal assistance to the prediction. In conclusion, high CD concentration is indicative of ER of patients, and c-erbB-2 overexpression correlates with OS of patients.     

Site of primary tumor has a prognostic role in operable breast cancer: the international breast cancer study group experience.

PURPOSE: Cancer presenting at the medial site of the breast may have a worse prognosis compared with tumors located in external quadrants. For medial tumors, axillary lymph node staging may not accurately reflect the metastatic potential of the disease. PATIENTS AND METHODS: Eight-thousand four-hundred twenty-two patients randomly assigned to International Breast Cancer Study Group clinical trials between 1978 and 1999 were classified as medial site (1,622; 19%) or lateral, central, and other sites (6,800; 81%). Median follow-up was 11 years. RESULTS: A statistically significant difference was observed for patients with medial tumors versus those with nonmedial tumors in disease-free survival (DFS; 10-year DFS, 46% v 48%; HR, 1.10; 95% CI, 1.02 to 1.18; P = .01) and overall survival (10-year OS 59% v 61%; HR, 1.09; 1.01 to 1.19; P = .04). This difference increased after adjustment for other prognostic factors (HR, 1.22; 95% CI, 1.13 to 1.32 for DFS; and HR, 1.24; 95% CI, 1.14 to 1.35 for OS; both P = .0001). The risk of relapse for patients with medial presentation was largest for the node-negative cohort and for patients with tumors larger than 2 cm. In the subgroup of 2,931 patients with negative axillary lymph nodes, 10-year DFS was 61% v 67%, and OS was 73% v 80% for medial versus nonmedial sites, respectively (HR 1.33; 95% CI, 1.15 to 1.54; P = .0001 for DFS; and HR 1.40; 95% CI, 1.17 to 1.67; P = .0003 for OS). CONCLUSION: Tumor site has a significant prognostic utility, especially for axillary lymph node-negative disease, that should be considered in therapeutic algorithms. New staging procedures such as biopsy of the sentinel internal mammary nodes or novel imaging methods should be further studied in patients with medial tumors.     

Prognostic importance of c-erbB-2 expression in breast cancer. International (Ludwig) Breast Cancer Study Group.

PURPOSE: To evaluate the prognostic importance of immunocytochemically determined c-erbB-2 overexpression in the primary tumors of patients with breast cancer. PATIENTS AND METHODS: Primary tumors from 1,506 breast cancer patients (760 node-negative and 746 node-positive) who were treated in the International (Ludwig) Breast Cancer Study Group Trial V were studied. Node-negative patients were allocated randomly to either a single cycle of perioperative chemotherapy (PeCT) or no adjuvant treatment, and node-positive patients received either a prolonged chemotherapy (with tamoxifen for postmenopausal patients) or a single perioperative cycle. RESULTS: Tumors from 16% of the node-negative patients and 19% of the node-positive patients were found to be c-erbB-2-positive. In both groups c-erbB-2 positivity correlated with negative progesterone receptors (PR), negative estrogen receptors (ER), and high tumor grade. Lobular carcinomas were all negative, and, thus support the view that such tumors represent a defined subtype of breast carcinoma. The expression of c-erbB-2 was prognostically significant for node-positive but not for node-negative patients. However, in both subgroups, the prognostic significance was greater for patients who had received more adjuvant therapy. For node-positive patients, the effect of prolonged-duration therapy on disease-free survival (DFS) was greater for patients without c-erbB-2 overexpression (hazards ratio [HR], = 0.57; 95% confidence interval [CI], 0.46 to 0.72) than for those with c-erbB-2 overexpression (HR, 0.77; 95% CI, 0.51 to 1.16). Similarly, for node-negative patients, the effect of PeCT on DFS was greater for those without c-erbB-2 overexpression (HR, 0.82; 95% CI, 0.61 to 1.09) than for those with c-erbB-2 overexpression (HR, 1.22; 95% CI, 0.66 to 2.25). CONCLUSION: We conclude that tumors with overexpression of the c-erbB-2 oncogene are less responsive to cyclophosphamide, methotrexate, and fluorouracil (CMF)-containing adjuvant therapy regimens than those with a normal amount of gene product.     

乳腺导管原位癌与导管原位癌伴微浸润的临床比较

目的 分析乳腺导管原位癌(DCIS)及原位癌伴微浸润(DCIS-MI)患者治疗模式变化、临床特征、治疗结果及预后因素。方法 回顾性分析中国医学科学院肿瘤医院1999-2013年收治的866例女性患者资料。DCIS患者631例,DCIS-MI患者235例。用Kaplan-Meier法计算局控(LC)、无瘤生存(DFS)、总生存(OS)率,并Logrank检验和单因素预后分析。结果 DCIS及DCIS-MI两组之间OS、LC及DFS相近(P>0.05)。单因素分析显示Her-2阳性为OS及DFS影响因素,保乳未放疗患者LC和DFS劣于全乳切除术患者。结论 导管原位癌和导管原位癌伴微浸润总体生存结果类似,Her-2阳性为OS及DFS预后不良因素,保乳未放疗患者的LC和DFS劣于全乳切除术。     

乳腺导管原位癌与导管原位癌伴微浸润的临床比较

目的 分析乳腺导管原位癌(DCIS)及原位癌伴微浸润(DCIS-MI)患者治疗模式变化、临床特征、治疗结果及预后因素。方法 回顾性分析中国医学科学院肿瘤医院1999-2013年收治的866例女性患者资料。DCIS患者631例,DCIS-MI患者235例。用Kaplan-Meier法计算局控(LC)、无瘤生存(DFS)、总生存(OS)率,并Logrank检验和单因素预后分析。结果 DCIS及DCIS-MI两组之间OS、LC及DFS相近(P>0.05)。单因素分析显示Her-2阳性为OS及DFS影响因素,保乳未放疗患者LC和DFS劣于全乳切除术患者。结论 导管原位癌和导管原位癌伴微浸润总体生存结果类似,Her-2阳性为OS及DFS预后不良因素,保乳未放疗患者的LC和DFS劣于全乳切除术。     

Prognostic correlation of basic fibroblast growth factor and vascular endothelial growth factor in 1307 primary breast cancers

This study was designed to investigate the possible relationship between the protein expression of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) with p53 status, breast cancer prognostic factors, metastatic site, and survival after adjuvant therapy. Basic fibroblast growth factor and VEGF expression were determined by enzyme-linked immunosorbent assays in cytosol specimens obtained from 1307 patients with T1-3 primary breast cancer (789 node-negative, 518 node-positive) diagnosed between 1990 and 1997. The median follow-up time was 70 months. Increased bFGF expression was more frequently found in tumors with low VEGF expression (r = -0.286; P = 0.095). Increased bFGF was associated with smaller tumors (P < 0.001), absence of axillary metastasis (P = 0.003), low S-phase fraction (P < 0.001), and longer recurrence-free survival (RFS; P = 0.0038) and overall survival (OS; P = 0.0316). Vascular endothelial growth factor was a prognostic factor for RFS (P < 0.0001) and OS (P < 0.0001) in univariate and multivariate analyses (RFS: 95% CI, 1.1-1.7; P = 0.036; OS: 95% CI, 1.2-2.2; P = 0.002), whereas bFGF expression was not correlated with RFS or OS. Increased VEGF content was correlated with shorter survival after adjuvant endocrine therapy (RFS, P = 0.0004; OS, P = 0.0009). Patients with estrogen receptor-negative disease were excluded from the analysis. Basic fibroblast growth factor was not a prognostic factor after adjuvant systemic therapy, nor was it related to metastatic site. Expression of VEGF is an independent prognostic factor for patients with primary breast cancer. High bFGF expression was related to good prognostic features and longer survival times, but did not add prognostic information in multivariate analysis. The results might implicate that different angiogenic pathways exist in human breast cancer.