不同亚型乳腺癌的临床特征和预后分析

目的分析不同亚型乳腺癌患者的临床特征、生存情况和预后.方法收集2002年2月至2004年2月昆明医学院第一附属医院收治的具有完整临床病理和随访资料的可手术乳腺癌304例,根据免疫组化ER、PR和HER-2的检测结果分为Luminal型、HER-2阳性型和三阴性乳腺癌,对比分析不同亚型乳腺癌患者的临床特征、复发及生存情况.结果 Luminal型、HER-2阳性型和三阴性乳腺癌患者分别占53.0%、20.4%和26.6%,中位发病年龄分别为50.8岁、50.3岁和47.1岁.Luminal型乳腺癌的组织学分级较低,I级者占43.1%;HER-2阳性型乳腺癌多见于绝经前（66.1%）,组织学分级介于Luminal型和三阴性乳腺癌患者之间;三阴性乳腺癌的发病年龄较轻,有较高的乳腺癌家族史（占9.9%）,组织学分级较高,Ⅲ级者占49.0%.三组患者在绝经状况、肿瘤分期、病理类型、腋淋巴结转移率方面差异无统计学意义（P〉0.05）.随访至2009年2月,中位随访71个月（60～84个月）.HER-2阳性型和三阴性乳腺癌患者的复发转移率显著高于Luminal型患者,HER-2阳性型和三阴性乳腺癌的复发转移率比较无统计学意义（P〉0.05）,但HER-2阳性型患者骨转移的发生率较高（46.7%）,三阴性乳腺癌患者则易发生肺转移,发生率为46.7%（P〈0.05）.Luminal型、HER-2阳性型和三阴性乳腺癌患者的5 a无病生存率（DFS）分别为90.1%、75.8%和76.5%,总生存率（OS）分别为96.9%、85.5%和87.7%（P〈0.05）.结论不同亚型乳腺癌患者具有不同的临床特征、复发转移方式和生存情况.

Clinical Characteristics and Prognosis of Different Subtypes of Breast Cancer

Objective To analyze the clinical characteristics,survival,and prognosis of the patients with different molecular subtypes of breast cancer.Methods Clinical data of 304 patients with histopathologically confirmed resectable breast cancer,treated in the 1st Affiliated Hospital of Kunming Medical University from Feb.2002 to Feb.2004,were collected and analyzed in this study.ER,PR and HER-2 in all the excised tissues were determined by immunohistochemistry,and according to the results,the patients were divided into luminal,HER-2 and triple-negative breast cancer.The clinical characteristics,recurrence and survival of the patients with different subtypes of breast cancer were analyzed.Results In this study,luminal,HER-2 and triple-negative breast cancer accounted for 53.0%,20.4% and 26.6%,and the median age of patients with the three subtypes was 50.8,50.3and 47.1,respectively.Histological grade of luminal type was lower than other subgroup of breast cancer.The percentage of luminal type with histological grade I was 43.1%.HER-2 type was commonly seen in premenopausal women（66.1%）,its histological grade was between luminal and triple-negative type.Triple-negative breast cancer was more likely to be found in younger patients frequently with a familial history of breast cancer（9.9%）.Histological grade of triple-negative breast cancer was higher than other groups.The percentage of triple-negative patients with histological grade III was 49.0%.Among the three type patients,there was no significant difference in menopausal status,tumor stage,pathologic types and lymph node metastasis.By Feb.2009,the median time of follow-up was 71 months（60～84 months）.Patients with HER-2 or triple-negative breast cancer were found to have a significantly higher recurrence and metastasis rate than the patients with luminal type breast cancer,but no significant difference was observed between triple-negative and HER-2 types.HER-2 type patients were more likely to develop bone metastases than triple-negative patients（46.7% vs 13.3%,P0.05）,and triple-negative patients were more likely to develop lung metastases than HER-2 patients（46.7% vs 20.3%,P0.05）.Up to February 2009,the 5-year disease-free rates（DFS）for patients with Luminal,HER-2 and triple-negative types were 90.1%,75.8% and 76.5%（P0.05）,respectively.The overall 5-year survival rates（OS）of the three groups were 96.9%,85.5% and 87.7%（P0.05）,respectively.Conclusion Patients with different subtype of breast cancer have different clinical characteristics,recurrence pattern and prognosis.