ER PR 单阳性表达乳腺癌患者临床病理特征和预后分析*

目的:探讨不同的ER、PR表达对原发性侵袭性乳腺癌患者预后的影响，重点研究ER+/PR- 和ER-/PR+ 单阳性表型肿瘤的临床病理特征和预后差异。方法:回顾性分析1998年10月至2004年5 月间天津医科大学附属肿瘤医院收治的1 054 例原发性侵袭性乳腺癌患者的病例资料及随访结果，比较不同的ER、PR表达乳腺癌患者的临床病理特征和预后，明确ER+/PR- 和ER-/PR+ 单阳性表型肿瘤之间存在的差异。计算生存率采用Kaplan-Meier 方法，生存率比较应用Log-rank 检验。经COX多因素分析得出独立的预后影响因素。结果:ER+/PR- 表型肿瘤易出现于年长、绝经后的女性，肿瘤直径较小，组织分化程度较高。生存分析显示:ER+/PR+ 组预后优于ER-/PR- 组（OS:P=0.000，DFS :P=0.000），ER或PR单阳组预后介于ER+/PR+ 组和ER-/PR- 组之间。相对于ER-/PR- 表型肿瘤，ER+/PR- 的生存优势强于ER-/PR+ ，ER+/PR- 的无瘤生存优于ER-/PR+（P=0.035），而两者之间总体生存无明显差异（P=0.890）。 不同的ER、PR阳性表达是影响乳腺癌患者内分泌治疗的无瘤生存的独立因素（P=0.023）。 结论:ER+/PR- 和ER-/PR+ 是两种临床病理特征和预后完全不同的乳腺癌，ER-/PR+ 肿瘤表现的侵袭性行为更强，应该采取更为积极的治疗措施。ER-/PR+ 表型乳腺癌可能具有独特的生物学特征。 

Analysis of the Clinicopathologic Characteristics and Prognosis of Breast Cancer Patients with ER or PR Single-positive Status

Objective:To investigate the clinicopathologic characteristics and prognosis of primary invasive breast can-cer patients with ER/PR single-positive status.Methods:A total of 1.054 patients with primary invasive breast cancer with different ER or PR status seen in our hospital between October 1998 and May 2004 were analyzed.Patients were stratified according to ER and PR expression.The study was focused on the single-positive groups(ER+/PR-and ER-/PR+)and as-sessed their main characteristics and evaluated the prognostic difference between the double positive and negative tu-mors.The survival rate of breast cancer was calculated by Kaplan-Meier analysis and log-rank test.COX multivariate analy-sis was conducted to determine the independent risk factors of prognosis.Results:The prognosis of double-positive tumors was best in different receptor groups and was better in single-positive group than in double-negative group.The majority of ER+/PR- tumors were small and well-differentiated.They were more frequently seen in elder and postmenopausal women.The survival analysis showed no difference in overall survival between the two groups(P=0.890).However,disease-free survival was better in ER+/PR- patients than in ER-/PR+ patients (P=0.035).Compared with the double-negative pheno-type,ER+/PR- group was associated with better outcome.In patients with single-positive receptor who received adjuvant hormone therapy, different ER or PR positive status was an independent risk factor for disease-free survival(P=0.023).Conclusion:ER+/PR- and ER-/PR+ tumors were two distinct groups of breast cancer in clinicopathologic characteristics and prognosis.ER-/PR+ breast cancer patients might need active treatment because of its aggressive behaviors.