不同分子分型的HR阴性乳腺癌临床病理特征及预后的研究

目的： 探讨激素受体 (hormone receptor，HR)阴性浸润性乳腺癌的分子分型情况，以及不同分子分型的临床病理特征和预后?方法：应用组织芯片技术及免疫组化将所选200例HR阴性包括雌激素受体 (estrogen receptor，ER)和孕激素受体 (progesterone receptor ，PR)均为阴性]浸润性乳腺癌，依据HER2及基底细胞标记包括细胞角蛋白5/6 (cytokeratin 5/6，CK5/6)，细胞角蛋白14 (cytokeratin14，CK14)及上皮生长因子受体 (epidermal growth factor receptor，EGFR)]表达情况，分为以下类型：HER2过表达型、基底细胞样型及裸型；HER2过表达型又分两类亚型：单纯性HER2过表达型、基底细胞样-HER2过表达型；比较不同分子分型乳腺癌的病理特征及预后。结果：HR阴性乳腺癌具有病理分级高，临床分期晚，发病年龄近绝经期等特点，各分型间差异无统计学意义；基底细胞样-HER2过表达型远处转移率高于基底细胞样型 (P<0.05)，其5年无病生存率及5年总生存率低于各分型 (P<0.05)。 结论：基底细胞样型并非影响乳腺癌预后的独立因素，基底细胞样-HER2过表达型乳腺癌较基底细胞样型具有更差的预后情况。

The molecular phenotypes of hormone receptor-negative invasive breast cancers: clinicopathologic features and prognosis

OBJECTIVE: To explore the molecular phenotypes of hormone receptor (HR，including ER and PR)-negative invasive breast cancers，and how the phenotypes relate to clinicopathologic features and prognosis. METHODS：Using tissue microarray (TMA) and immunohistochemistry (IHC) methods，according to the expression of HER2 and basal markers (CK5/6，CK14， EGFR)，the subtypes of these HR-negative breast cancers were classified as follows：basal-like (HER2?，any of the basal marker+)，HER2 (HER2+)，and null/unclassified (HER2?，all the basal marker?). The phenotype HER2 was subdivided into pure-HER2 (HER2+，all the basal marker?) and basal-HER2 phenotype (HER2+，any of the basal marker+). We summarized the associations between each phenotype and clinicopathologic parameters，and compared the mean survival across the IHC subtypes. RESULTS：HR-negative invasive breast cancers was more likely to be high-grade，late-stage，and disease onset close to menopause. But with no significant difference among various molecular phenotypes. Patients with basal-HER2 phenotype had significantly poorer 5-year disease-free survival and 5-year overall survival than with basal-like tumors (P <0 .05). CONCLUSION：Basal-like phenotype was not an independent prognostic factor. Basal-HER2 phenotype showed significantly poorer 5-year overall and disease-free survival than basal-like and all the non basal-HER2 phenotypes in HR-negative breast cancers.