乳腺癌原发灶与转移灶分子分型指标表达差异的研究

目的 乳腺癌患者激素受体(hormone receptor,HR)、人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)和增殖细胞核抗原Ki-67的表达状态直接影响治疗方案的制订.本研究通过比较可手术乳腺癌原发灶与腋窝淋巴结转移灶及治疗后远处转移灶之间HR、HER2和Ki-67表达状况,探讨其表达的一致性,以期为乳腺癌患者综合治疗方案的制订提供参考.方法 选取2015-03-01-2016-04-30就诊于山东大学附属山东省肿瘤医院(162例)和梁山县人民医院(23例)的185例乳腺癌患者作为研究对象.患者均为女性,年龄24～79岁,中位年龄49岁.浸润性导管癌171例,浸润性小叶癌14例.初治直接接受手术治疗患者110例,其中有腋窝淋巴结转移77例;复发转移患者接受转移灶穿刺患者75例,其中肝脏转移43例,肺脏转移32例.所有标本均检测ER、PR、HER2和Ki-67表达,比较原发灶与腋窝淋巴结及远处转移灶的表达情况.结果 原发灶与腋窝淋巴结转移灶ER、PR、HER2和Ki-67表达差异均无统计学意义(均P＞0.05),ER变化率为3.9％,PR为7.8％,HER2为11.7％,Ki-67为20.8％.原发灶与远处转移灶比较,PR和Ki-67表达差异有统计学意义(均P值＜0.05),而ER和HER2表达差异无统计学意义(均P＞0.05),ER变化率为21.3％,PR为29.3％,HER2为18.7％,Ki-67为29.3％.结论 乳腺癌原发灶与转移腋窝淋巴结ER、PR、HER2和Ki-67表达状况一致性较高;原发灶与远处转移灶PR和Ki-67的表达存在差异,ER和HER2的表达无差异,这可能受多种因素的影响,建议对原发灶及转移灶同时进行生物学信息的检测,为患者制订治疗方案提供可靠的生物学信息.

Difference of molecular typing between primary lesions,lymph node metastases and distant metastases lesions

OBJECTIVE The expression of hormone receptor,human epidermal growth factor receptor 2 and Ki-67 in patients with breast cancer has a direct impact on the formulation of treatment protocols.Expression of HR,HER2 and Ki-67 between primary tumor,axillary lymph node metastasis and distant metastasis is still controversial.This study aimed to investigate the consistency of breast cancer HR,HER2 and Ki-67 expression in the above case,in order to guide the formulation of breast cancer patients with comprehensive treatment programs.METHODS Totally 185 cases of breast cancer patients were collected,who received treatment in Shandong Cancer Hospital Affiliated to Shandong University (n=162) and Liangshan County Hospital (n=23) from March 2015 to April 2016.Totally 110 initial patients were received direct treatment of surgery in which 77 cases with axillary lymph node metastasis,and there were 75 patients with distant metastasis (43 cases of liver metastasis;lung metastasis in 32 cases).The expression of HR,HER2 and Ki-67 were detected by immune histochemistry,comparing the results of the primary tumor and axillary lymph node metastasis and distant metastasis specimen.RESULTS In primary and metastatic axillary lymph nodes,the expression difference of ER,PR,HER2 and Ki-67 was not statistically significant (all P＞0.05).Expression change rates of ER,PR,HER2 and Ki-67 were 3.9％,7.8％ 11.7％ and 20.8％,respectively.Comparison of ER,PR,HER2 and Ki-67 expression in 75 cases of distant metastases in primary and distant metastases,the expression difference of PR and Ki-67 was statistically significant (all P＜0.05),and the expression difference of ER and HER2 was not statistically significant (all P＞0.05).The total change rates of ER,PR,HER2 and Ki-67 were 21.3％,29.3％,18.7％ and 29.3％,respectively.CONCLUSIONS Expression of ER,PR,HER2 and Ki-67 in direct operation and metastatic axillary lymph nodes is high consistency.It is suggested that the expression of HR,Ki-67 and HER2 should be detected in the primary tumor and metastatic lymph node metastasis.The expressions of PR and Ki-67 are significantly different between primary and distant metastases,but there is no significant difference in the expression of ER and HER2,which may be influenced by many factors.It is suggested that the patients with distant metastases can simultaneously detect the biological information of the primary and metastatic lesions,so as to seek more treatment opportunities for the patients.