三阴性乳腺癌的临床病理特征及预后分析

目的 探讨三阴性乳腺癌(TNBC)患者的临床病理特点、生存情况和预后影响因素.方法 收集免疫组化检测雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)均阴性的108例乳腺癌患者的临床病理资料,观察其长期生存状况.结果 中位发病年龄47岁.108例TNBC患者中,有乳腺癌家族史者8例,卵巢癌家族史者3例,自身曾患卵巢癌者1例.浸润性导管癌占87.0%,组织学分级多为Ⅱ、Ⅲ级.T1、T2期患者占92.6%,有淋巴结转移的患者占49.1%,Ⅰ、Ⅱ期患者占75.0%.5年无病生存率、无远处转移生存率、无局部复发生存率和总生存率分别为68.1%、70.9%、72.1%和76.9%.单因素分析结果显示,淋巴结转移、脉管瘤栓与TNBC预后有关.多因素分析结果显示,淋巴结转移是TNBC预后的独立影响因素(RR=5.944,P=0.001).结论 TNBC在我国的发病情况与白色人种相当,较黑色人种低.散发性乳腺癌可能是我国TNBC发病的主体.淋巴结转移是TNBC的独立预后影响因素.经放疗和以蒽环类药物为主的化疗后,我国TNBC患者的生存率与白色人种患者接近,较黑色人种患者高.

Analysis of clinicopathological characteristics and prognosis for triple negative breast cancer: a report of 108 cases

OBJECTIVE: To analyze the incidence, clinical and pathological characteristics, survival and prognostic factors of so-called triple negative breast cancer (TNBC) with negative estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2). METHODS: Clinical and pathological as well as follow-up data of TNBC patients between Jan. 1999 to Dec. 2002 were collected and analyzed. RESULTS: Totally, the pathological result of 1175 breast cancer patients were retrospectively reviewed, and 158 patients were found with negative ER, negative PR and HER-2 scored as 0 or 1 + by immunohistochemistry staining. Eventually, only 108 patients with ER-negative, PR-negative and HER-2-negative (score: 0 ) were analyzed. Of the 108 patients, 8 had breast cancer family history, 3 oophoroma family history and one had ever suffered from oophoroma herself. The median age of the 108 TNBC patients was 47.0 years, and 75.0% of them had stage I or II disease. The majority of pathological types were grade II or III invasive ductal carcinomas, and 92.6% of the tumors were staged as T1 or T2. Lymph node metastases were detected in 49. 1% of these patients. Event-free survival, distant metastasis-free survival, local relapse-free survival and overall survival at 5 years were 68.1%, 70.9%, 72.1% and 76.9%, respectively. Though lymph node metastasis and lymph-vascular invasion were all found to be correlated with overall survival, however, only the lymph node metastasis was an independent factor that affected the overall survival revealed by the Cox proportional hazard model analysis. CONCLUSION: Triple negative breast cancer has distinct clinical and pathologic characteristics. The incidence of triple negative breast cancer in Chinese is similar to that in white but lower than that in black women. Most of the triple negative breast cancer in China is composed of sporadic breast cancer. Lymph node metastasis is an important independent prognostic factor. Clinical outcome of this series is similar to that in white women, while better than that in black women after appropriate radiotherapy and anthracycline-based chemotherapy. Further study is still necessary to explore new treatment in order to improve the prognosis of triple negative breast cancer.