青年乳腺癌及其分子亚型的临床特征分析

目的探讨青年乳腺癌及其分子亚型的临床病理特点及预后情况。方法回顾性分析2003年5月至2009年12月期间南京医科大学第一附属医院乳腺外科收治的77例青年乳腺癌患者（≤35岁）的临床资料，将其中69例浸润性癌，按照ER、PR和HER-2的表达情况分成4种分子亚型，即Luminal A型、luminal B型、HER-2过表达型和三阴性乳腺癌，并分析各亚型的临床病理特点及预后情况。定量资料的比较采用单因素方差分析，定性资料的比较采用非参数检验或Fisher确切概率检验。结果全组青年乳腺癌患者占同期乳腺癌的7．2％（77／1065），其中T3期（〉5cm）38例（49．4％，38／77），淋巴结转移37例，转移率为48．1％（37／77）。临床分期Ⅱ、Ⅲ期的患者分别占42．9％（33／77）和35．1％（27／77）。77例患者中浸润性癌69例，其中luminal A型34例（49．3％，34／69），luminal B型8例（11．6％，8／69），HER-2过表达型12例（17．4％，12／69），三阴性乳腺癌15例（21．7％，15／69）。各亚型乳腺癌在年龄、肿瘤直径、淋巴结转移、临床分期、脉管浸润、肿瘤分级及p53分布的差异均无统计学意义（P〉0．050）。结论青年乳腺癌患者临床分期比较晚，但不同分子亚型乳腺癌的临床病理特点无差别，分子分型是否有利于指导青年乳腺癌患者的个体化治疗有待于进一步研究。

Clinical characteristics of different molecular subtypes of breast cancer in young patients

Objective To investigate the clinical characteristics and prognosis of different molecular subtypes of breast cancer in young patients. Methods The clinical data of 77 young breast cancer patients （ ≤ 35 years old） treated in Department of Breast Surgery, the First Affiliated Hospital of Nanjing Medical University, from May 2003 to December 2009 were retrospectively analyzed. Of these 77 patients, 69 were diagnosed as having invasive cancers, then they were categorized into four molecular subtypes： luminal A, luminal B, HER-2 over-expressing and triple negative, based on immunohistochemistry （IHC） of ER, PR, HER-2 expression. The clinical characteristics and prognosis of different molecular subtypes were analyzed. One-way ANOVA was used for quantitative data, and nonparametric rank test or Fisher＇ s exact test was used for qualitative data. Results The number of young breast cancer patients accounted for 7.2% （77/1065） of this group in the same period （1065 patients）, including 38 （49.4%, 38/77） in T3 stage （〉5 cm）, and 37 （48. 1% , 37/77 ） with axillary lymph node metastases. The proportions of clinical stage Ⅱ and Ⅲ were 42. 9% （33/77） and 35. 1% （27/77） respectively. Sixty-nine patients had invasive carcinoma among the 77 young patients, including 34 patients （49. 3%, 34/69） in luminal A subtype, 8 （ 11.6% ,8/69） in luminal B subtype, 12 （17.4%, 12/69） in HER-2 over-expressing subtype, and 15 （21.7%, 15/69） in triple negative subtype. There were no statistically significant differences among different molecular subtypes regarding the age, tumor size, lymph node metastasis, clinical stage, lymph vascular invasion, tumor grade, and p53 status （P〉0. 050）. Conclusions The clinical stage of young breast cancer patients is more advanced, but there are no significant differences in clinicopathologic characteristics among different molecular subtypes. Furthermore, whether the molecular subtype is valuable to guide the individualized treatment of young breast cancer patients still needs further confirmation.