HER-2、ER和PR阴性乳腺癌的病理生物学特性及其影响预后的因素

目的 探讨表皮生长因子受体-2（HER-2）、雌激素受体（ER）和孕激素受体（PR）阴性乳腺癌（TNBC）的病理生物学特性及其影响预后的因素.方法 回顾性分析329例经手术和病理证实为乳腺癌患者的临床资料,根据HER-2、ER和PR的表达情况,将其分为：TN组（HER-2、ER和PR均为阴性）、HER-2组（HER-2阳性,ER和PR均为阴性）、HR组（ER阳性,PR和HER-2均为阴性或阳性）,对照分析三组病理生物学特征和P53阳性表达,采用Kaplan-Meier法分析5年总生存率和无瘤生存率.结果 TN组为20.97%（69/329）,HER-2组为34.04%（112/329）,HR组为44.98%（148/329）.TN组淋巴结阳性率为55.07%（38/69）,高于HER-2组43.24%（64/148）和HR组42.86%（48/112）,差异有统计学意义（χ2=12.57,P＜0.05）.TN组P53阳性表达率、术后复发率和远处转移率分别为44.93%、27.54%和20.29%,均高于HER-2组（20.54%、16.07%、16.96%）和HR组（18.24%、12.84%、10.81%）,差异有统计学意义（χ2=12.23、8.36,P＜0.05）.比较三组乳腺癌的肿瘤≥5 cm、Ⅲ期、Ⅲ级和浸润性导管癌,差异有统计学意义（χ2=7.25、8.79、9.23、8.48,P＜0.05）.三组5年总生存率分别为75.36%、82.14%和85.14%;5年无瘤生存率分别为68.12%、78.57%和82.43%,差异有统计学意义（χ2=8.52,P＜0.05）.结论 TNBC病理生物学特性为P53阳性表达率高,肿瘤侵袭性强,局部复发率高,淋巴结转移率高,远处转移早,5年无瘤生存率低,是影响TNBC预后的主要因素.

A study on Pertinence of pathologic and biology features in HER-2, ER and PR negative breast cancer

Objective To analyze the pathologic and biology features and prognosis of HER-2,ER and PR negative breast cancer(TNBC).Methods Clinic pathologic data of 329 breast cancer patients was retrospectively analyzed. The expression of HER-2, ER, PR and P53 was determined by immunohistochemistry. The patients were divided into three groups, including TN group HER-2 (-), ER (-), PR (-)], HER-2 group HER-2(+),ER(-),PR(-)] and HR group ER(+),PR(-) or (+),HER-2(-) or (+) ].The pathology and biology features and P53 masculine expression of the three groups were compared.The 5-year overall survival and disease free survival were analyzed by Kaplan-Meier method.Results Of the 329 patients, 20.97% (69/329) was TN group, 34.04% (112/329)was HER-2 group, and 44.98% (148/329) was HR group.The percentage of with lymph node metastasis in TN group 55.07% (38/69) was higher than that in HER-2 group 42.86% (48/112) and HR group 43.24% (64/148) (χ2 = 12.57, P ＜ 0.05).The rates of P53 positive, operation recurrence and metastasis in TN group were 44.93%, 27.54% and 20.29%, which were higher than that in HER-2 group (20.54% ,16.07%,16.96%) and HR group (18.24%, 12.84%, 10.81%) (χ2=12.23, 8.36, P ＜0.05).The ratio of tumor ≥5cm, Ⅲ stages, Ⅲ grade and soakage canula cancer among three groups had statistical difference (χ2 = 7.25,8.79,9.23,8.48, P ＜ 0.05).The 5-year overall survival in three groups were 75.36%,82.14% ,85.14% and disease free survival were 68.12% ,78.57% ,82.43% (χ2 =8.52, P ＜0.05).Conclusion The pathology and biology traits of TNBC were high rate of P53 (+) and recurrence and lymph node metastasis.The most important factor for poor prognosis of TNBC was the low rate of disease free survival for 5 years.