不同分子亚型乳腺癌的临床病理特征及预后分析

目的 探讨乳腺癌各分子亚型的临床特点及其预后情况.方法 分析1153例可手术乳腺癌患者的临床病理资料,根据雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(Her-2)的表达情况将乳腺癌分为4种分子亚型,即Luminal A型、Luminal B型、Her-2过表达型和Basal-like型.分析各分子亚型乳腺癌患者在年龄、肿瘤大小、淋巴结转移状况、临床分期和预后的差异及影响预后的因素.结果 1153例患者中,Luminal A型791例(68.6%),Luminal B型50例(4.3%),Her-2过表达型53例(4.6%),Basal-like型259例(22.5%).各分子亚型在年龄、肿瘤大小、淋巴结转移状况、临床分期的差异均无统计学意义(均P>0.05).有完整随访资料的1006例患者中,Her-2过表达型的远处转移率(17.0%)显著高于其他亚型(P=0.005),而各分子亚型间的局部复发率差异无统计学意义(P>0.05).Kaplan-Meier法分析结果显示,Her-2过表达型患者的7年无病生存率和9年总生存率最低(均P<0.05).单因素和多因素分析结果均显示,淋巴结转移状况和分子分型是影响乳腺癌患者无病生存及总生存的独立预后因素.结论 Her-2过表达型乳腺癌患者的预后最差.乳腺癌的分子分型对判断患者预后可能具有重要临床意义,有望成为今后制订乳腺癌个体化治疗方案的重要依据.

Abstract：

Objective To investigate the clinical characteristics and prognosis of different breast cancer molecular subtypes.Methods Clinicopathological and follow-up data of 1153 cases of operable breast cancer were analyzed retrospectively.Their molecular subtypes were categorized as luminal A, luminal B, Her-2 over-expressing and basal-like subtypes, based on detection of ER, PR, Her-2 expression.The correlation of prognosis of different molecular subtypes with age, tumor size, lymph node status and clinical staging was analyzed.Results Among the 1153 cases, 791 cases (68.6%) were of luminal A subtype, 50 cases (4.3%) luminal B subtype, 53 cases (4.6%) Her-2( + )subtype, and 259 cases (22.5%) basallike subtype.There were no statistically significant differences among different molecular subtypes regarding the age, tumor size, lymph node status, and clinical stage.1006 cases had complete follow-up data and the analysis showed that distant metastasis of Her-2 over-expressing subtype was significantly higher than that in other subtypes ( P = 0.005 ), but the differelices of local recurrence rate in different molecular subtypes was not statistically significant (P >0.05).Kaplan-Meier method was used to analyze the survival prognosis of different molecular subtypes, showing both DFS rate and OS rate of Her-2 over-expressing subtype were the lowest, with a statistically significant difference (Log rank test, P < 0.05 ).Univariate and multivariate analyses showed that molecular typing and lymph node status were independent prognostic factors affecting both DFS and OS.Conclusions Her-2 over-expressing subtype has the worst prognosis.Molecular subtypes may provide important information to predict the prognosis of breast cancer and might be an important basis for individualized treatment of breast cancer in future.

Clinical features and prognosis analysis of different breast cancer molecular subtypes

Objective To investigate the clinical characteristics and prognosis of different breast cancer molecular subtypes.Methods Clinicopathological and follow-up data of 1153 cases of operable breast cancer were analyzed retrospectively.Their molecular subtypes were categorized as luminal A, luminal B, Her-2 over-expressing and basal-like subtypes, based on detection of ER, PR, Her-2 expression.The correlation of prognosis of different molecular subtypes with age, tumor size, lymph node status and clinical staging was analyzed.Results Among the 1153 cases, 791 cases (68.6%) were of luminal A subtype, 50 cases (4.3%) luminal B subtype, 53 cases (4.6%) Her-2( + )subtype, and 259 cases (22.5%) basallike subtype.There were no statistically significant differences among different molecular subtypes regarding the age, tumor size, lymph node status, and clinical stage.1006 cases had complete follow-up data and the analysis showed that distant metastasis of Her-2 over-expressing subtype was significantly higher than that in other subtypes ( P = 0.005 ), but the differelices of local recurrence rate in different molecular subtypes was not statistically significant (P >0.05).Kaplan-Meier method was used to analyze the survival prognosis of different molecular subtypes, showing both DFS rate and OS rate of Her-2 over-expressing subtype were the lowest, with a statistically significant difference (Log rank test, P < 0.05 ).Univariate and multivariate analyses showed that molecular typing and lymph node status were independent prognostic factors affecting both DFS and OS.Conclusions Her-2 over-expressing subtype has the worst prognosis.Molecular subtypes may provide important information to predict the prognosis of breast cancer and might be an important basis for individualized treatment of breast cancer in future.