三阴乳腺癌受体表型转化情况对乳腺癌患者临床预后的影响

目的 评价乳腺癌患者雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)的表达及复发前后受体表型的转化情况对解救治疗疗效及临床预后的影响.方法 纳入解放军307医院1994年9月-2011年11月收治乳腺癌患者211例,根据ER、PR和HER-2受体表型转化情况分为3组.A组(n=20):原发肿瘤灶为三阴乳腺癌(ER、PR和HER-2表达均为阴性,TNBC),复发转移后转化为非TNBC；B组(n=73):原发肿瘤灶为非TNBC,复发转移后转化为TNBC;C组(n=118):原发肿瘤及复发转移灶均为TNBC.对患者的一般资料进行总结,分析复发转移情况、解救治疗疗效及临床预后.结果 全组211例患者复发转移时中位年龄52(22 ～ 78)岁,以单发转移为主,首发转移最常见的部位依次为淋巴结、骨和皮肤.A、B、C三组患者的中位无病生存期分别为34.0、25.0、20.0个月.B、C组一、二、三线解救治疗的临床有效率显著高于A组(P=0.030、0.003、0.001),但A组在解救内分泌治疗中的临床获益率显著高于B、C组.211例患者的中位随访时间为68(20～127)个月.A、B、C三组复发后中位生存期分别为63.1、33.7、25.8个月(P=0.000),中位总生存期分别为156.7、67.8、47.4个月(P=0.000).结论 乳腺癌患者复发前后ER、PR和HER-2受体表型转化可影响临床预后,在制定解救治疗方案时应对ER、PR和HER-2受体的表达情况进行检测.

Effects of phenotype transformation of receptors of triple-negative breast cancer(TNBC) on clinical prognosis of patients with breast cancer

Objective To evaluate the expression of estrogen receptor(ER),progesterone receptor(PR) and human epidermis growth-factor receptor 2(HER-2),to determine the phenotype transformation of these receptors before and after recurrence and/or metastasis,and to explore the effects of expression and phenotype transformation of receptors on the treatment efficacy and clinical prognosis of patients with breast cancer.Methods Based on the phenotype transformation of ER,PR,and HER-2 receptor,211 breast cancer patients were assigned to 3 groups.Twenty patients of Group A were with primary triple-negative breast cancer(TNBC,defined as lacking expression of ER,PR and HER2) which transformed into non-TNBC after recurrence and/or metastasis,73 of Group B were with primary non-TNBC which transformed into TNBC after recurrence and/or metastasis,and 118 of Group C were with primary TNBC which was still TNBC after recurrence and/or metastasis.The phenotype transformation of receptors,recurrence/metastasis,and efficacy and clinical prognosis were analyzed following collection of general information of the patients.Results The median age of 211 recurrent patients was 52 years(range,22 to 78 years).Most of the patients exhibited solitary metastasis.The most common locations of the initial metastasis were lymph node,bone and skin.The median disease-free survival for Groups A,B,and C was 34.0,25.0,and 20.0 months,respectively.The clinical effect of Groups B and C was better than that of Group A for first-line,second-line,and third-line rescuing therapy(P=0.030,0.003,0.001).However,the clinical benefit rate of Group A was higher than those of Groups B and C for rescuing endocrine therapy.The median follow-up time of the 211 patients was 68 months(range,20 to 127 months),and the median survival after recurrence for Groups A,B,and C was 63.1,33.7,and 25.8 months respectively(P=0.000).The median overall survival for Groups A,B,and C was 156.7,67.8,and 47.4 months respectively(P=0.000).Conclusions The phenotype transformation of ER,PR and HER-2 may influence the clinical prognosis of patients with breast cancer.Therefore,the expression of ER,PR and HER-2 should be determined to ensure the efficacy of rescuing therapy.