双侧原发性乳腺癌ER、PR及HER-2表达特征及其与预后的关系

目的探讨雌激素受体（ER）、孕激素受体（PR）及人表皮生长因子受体2（HER-2）表达状态在双侧原发性乳腺癌（bilateral primary breast cancer，BPBC）患者第一癌与第二癌间的异同及其与预后的关系。方法回顾1961年1月至2007年12月间本院收治并确诊的565例BPBC患者临床资料，BPBC患者占同期全部乳腺癌患者的2．09％，其中同时性双侧乳腺癌（以6个月为界）198例占35．04％。采用免疫组织化学SP法进行ER、PR、HER-2检测。采用SPSS14．0中X^2检验比较ER、PR、HER-2在同时性和异时性BPBC表达的一致率及BPBC第一癌与第二癌ER、PR、HER-2的阳性率；采用Kaplan—Meier生存分析法研究BPBCER、PR和HER-2与患者预后的关系。结果同时性双侧原发性乳腺癌激素受体表达一致率要高于异时性双侧原发性乳腺癌（ER：X^2=5．30，P=0．02；PR：X^2=15．88，P=0，00）。双侧原发性乳腺癌两侧癌灶ER、PR和HER-2的表达没有区别（ER：X^2=2．02，P=0．16；PR：X^2=0．86，P=0．35：HER-2：X^2=0．70，P=0．79）。BPBC两侧ER和HER-2表达状况与其预后相关（ER：P=0．03，HER-2 P=0．03）。结论BPBC两侧癌灶激素受体及HER-2表达状态相仿。同时性BPBCER、PR表达的一致性高于异时性BPBC。两侧乳腺癌均检测激素受体和HER-2的表达对预后判断有一定的指导意义。

HER-2 and hormone receptor status in bilateral primary breast cancer and their association with prognosis

Objective To investigate the difference and similarity of HER2 and hormone receptor status between first and second tumors of bilateral primary breast cancer （ BPBC ）, and to study their association with prognosis. Method Medical records of BPBC 565 patients treated at the Tianjin Cancer Hospital during the period of January 1961 to December 2007 were retrospectively reviewed. BPBC patients constituted 2.09% of breast cancer patients in this period, and synchronous BPBC （198 cases, less than 6 months） constituted 35.04% of the total BPBC. The expression of estrogen receptor（ER） ,progesterone receptor（PR） ,HER-2 were detected with immunohistochemistry. Chi square test （ erosstabs of SPSS14.0 ） was used to find if there was difference in the ratio of coincidence between synchronous and asynchronous bilateral breast cancer, and difference in positive rate of ER, PR and HER-2 between the first and second cancer. Kaplan-Meier survival analysis of SPSS14.0 was used to study the association of ER, PR and HER-2 with prognosis. Result The ER and PR levels of two cancers of synchronous BPBC was higher than those of asynchronous BPBC （ ER ： X^2 = 5.30,P =0.02; PR：X^2 = 15.88,P =0.00）. There was no different in the state of ER,PR,HER-2（ER：X^2 = 2.02,P = 0.16 ; PR ： X^2 = 0.86,P = 0.35 ; HER-2 ： X^2 = 0.70,P = 0.79）. The ER and HER-2 expression status of both sides of BPBC were significantly correlated with prognosis and survival rate（ ER：P = 0.03. HER-2 P = 0.03）. Conclusion The first cancer and the second cancer of BPBC have resemblance hormone receptor and HER-2 state. Both sides of synchronous BPBC have higher concordance in the expressions of ER and PR than asynchronous BPBC. Detecting hormone receptor status and HER-2 of both sides of BPBC is of guiding significance.