不同分子亚型乳腺浸润性导管癌的临床特征与预后分析

目的 探讨不同分子亚型乳腺浸润性导管癌的临床病理特征及预后情况，并分析影响乳腺浸润性导管癌预后的因素。方法 收集西安交通大学医学院第一附属医院2000年1月至2012年12月收治的具有完整临床病理和随访资料的乳腺浸润性导管癌822例，基于免疫组化检测结果将乳腺癌分为4个基本分子亚型，即Luminal A型、Luminal B型、HER-2过表达型和三阴性乳腺癌，分析不同分子亚型乳腺浸润性导管癌患者在年龄、肿瘤大小、腋窝淋巴结转移、临床分期和预后方面的差异及影响预后的因素。结果 至随访截止日期，822例乳腺癌患者中有54例出现局部复发和转移，46例死亡，死亡率5.6％。不同分子亚型乳腺浸润性导管癌在发病年龄、肿瘤大小及临床分期中的差异有统计学意义（P＜0.05），而在腋窝淋巴结转移中的差异无统计学意义（P＞0.05）。单因素生存分析显示不同的发病年龄、临床分期、肿瘤大小、腋窝淋巴结转移状态以及分子亚型与乳腺癌预后相关（P＜0.05）。Cox多因素分析显示分子亚型及腋窝淋巴结转移状态为乳腺浸润性导管癌的独立预后因素，HER 2过表达型乳腺癌在各个分子亚型中预后最差。 结论 乳腺癌分子分型对于预测乳腺癌的预后具有重要意义，需进一步研究以在临床上指导乳腺癌患者的个体化治疗。

Clinicopathological characteristics and prognosis analysis among different molecular subtypes of breast in-vasive ductal carcinoma

Objective To investigate the relationship between molecular subtype and prognosis of invasive ductal carcinoma（IDC） of breast. Methods Clinical data of 822 patients with clinicopathologically resectable breast IDC in the First Affiliated Hospital of Xi'an Jiaotong University were collected from January 2000 to December 2012. Based on immunohistochemistry， we categorized the breast cancer as the following molecular subtypes：Luminal A， Luminal B， HER-2 over expression and triple-negative breast cancer（TNBC）. The correlation of prognosis in different breast cancer molecular subtypes with age， tumor size， lymph node metastasis and clinical stage were analyzed. Results Among 822 cases， 54 cases were found with recurrence or metastasis and 46 cases died with the mortality of 5.6％. The result showed statistical differences among different molecular subtypes of breast cancer regarding the age， tumor size and clinical stage（P＜0.05）, but no statistical difference was observed on the lymph node metastasis（P＞0.05）. Survival analysis showed that factors affecting the prognosis were age， clinical stage， tumor size， lymph node metastasis status and molecular subtypes. Multivariate analysis found that the molecular subtypes and lymph node metastasis status were the independent factors of breast cancer prognosis. The prognosis of HER-2 subtype breast cancer was the worst. Conclusion Breast cancer molecular subtypes classification has great significance in predicting the prognosis of breast cancer and needs further study to appy to clinical individual treatment of breast cancer patients.