三阴性乳腺癌与人表皮生长因子受体2过表达乳腺癌患者的临床病理特征和预后比较

目的 研究三阴性乳腺癌和人表皮生长因子受体2(Her-2)过表达乳腺癌患者的临床病理学特征以及无病生存期.方法 对1998至2003年间在上海长海医院确诊的770例乳腺癌患者进行回顾性分析,确立三阴性乳腺癌表型,并且与Her-2过表达乳腺癌进行比较,分析两组患者p53和上皮性钙黏蛋白(E-cadherin)状态以及发病年龄、肿瘤直径、肿瘤部位、组织学类型、分级、淋巴结转移状态、AJCC分期、是否化疗和手术方式之间的差异.对影响两组患者尤病生存率的相关因素进行分析.结果 770例患者中,三阴性乳腺癌96例,占12.5%;Her-2过表达乳腺癌164例,占21.3%.三阴性乳腺癌和Her-2过表达乳腺癌的p53和E-cadherin状态的差异均无统计学意义(均P>0.05).三阴性乳腺癌(71.9%)较Her-2过表达乳腺癌(58.5%)更容易发生淋巴结转移(P=0.034),并且三阴性乳腺癌中淋巴结转移≥10枚患者所占的比例(26.0%)明显大于Her-2过表达乳腺癌(12.2%,P=0.034).三阴性乳腺癌中组织学分级为3级的患者比例(67.7%)明显高于Her-2过表达乳腺癌(42.1%,P<0.0001).三阴性乳腺癌的肿瘤直径与淋巴结转移状态有关(P=0.024).三阴性乳腺癌和Her-2过表达乳腺癌的局部复发率和远处转移率的差异虽无统计学意义(P>0.05),但三阴性乳腺癌的无病生存期(61.85个月)明显短于Her-2过表达乳腺癌(78.69个月,P=0.047).结论 与Her-2过表达乳腺癌比较,三阴性乳腺癌的侵袭性更强,患者的无病生存期更短,预后更差.

Comparison of clinicopathologic characteristics and prognosis of triple-negative with Her-2-overexpressing breast cancer

Objective The aim of this study is to compare the elinieopathologie characteristics and disease-free survival of triple-negative breast cancer with human epidermal growth factor receptor-2-overexpressing (Her-2-overexpressing) breast cancer. Methods 770 breast cancer patients were surgically treated between 1998 and 2003 in Changhai Hospital ,Shanghai. Patients with triple negative phenotype were identified from those using immunochemistry and CISH. The differences between triple-negative breast cancer and Her-2-overexpressing breast cancers were analyzed in p53 and E-cadherin status, age, tumor size, tumor location, histological types and grading, lymph node metastasis, AJCC stage, chemotherapy and surgical procedures well as identified prognostic factors with regards to disease-free survival. Results Ninety-six (12.5%) patients with triple-negative phenotype, and 164 (21.3%) with Her-2-overexpresaing one were identified from the 770 breast cancer patients. No significant difference between two phenotypes in p53 and E-cadherin expression was found(P > 0.05). When compared with Her-2-overexpressing breast cancer patients, triple negative breast cancer patients experienced more lymph node metastases (71.9% vs. 58. 5%, P =0.034), and had a higher percentage of more than 10 lymph nodes metastases(26.0% vs. 12.2% ,P = 0.034) ; and showed a higher percentage of histological grade 3 (67.7% vs. 42. 1% ,P < 0. 0001). Furthermore, the tumor size was found to be related to lymph node metastasis in triple-negative breast cancer patients(P =0.024). No significant difference between the two phenotypes in the rates of local recurrence and distant metastasis was observed (P > 0.05). However, 5-year disease-free survival in patients with triple negative phenotype was significantly shorter than that in the patients with Her-2-overexpressing phenotype (61.85 mon vs. 78.69 mon, P = 0. 047). Conclusion Compared with Her-2-overexpressing breast cancer, triple-negative breast cancer is more malignant and has a poorer disease-free survival.