中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2008年
6期
456-461
,共6页
袁中玉%王树森%朱美琴%郑磊%罗文标%周中梅%管忠震
袁中玉%王樹森%硃美琴%鄭磊%囉文標%週中梅%管忠震
원중옥%왕수삼%주미금%정뢰%라문표%주중매%관충진
乳腺肿瘤%分子亚型%预后
乳腺腫瘤%分子亞型%預後
유선종류%분자아형%예후
Breast neoplasms%Molecular subtype%Prognosis
目的 分析Basal-like型、HER-2型和Luminal型乳腺癌患者的临床特征和预后,为乳腺癌的个体化治疗提供依据.方法 根据患者雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)的免疫组化结果,将1280例可手术乳腺癌患者分为Basal-like型、HER-2型和Luminal型3组,回顾性分析不同亚型乳腺癌的临床特征、复发转移及生存情况.结果 1280例乳腺癌患者中,Basal-like型、HER-2型和Luminal型乳腺癌分别占20.9%、23.2%和55.9%.Basal-like型乳腺癌年轻患者所占比例较大,<35岁者占13.4%;有乳腺癌家族史者所占比例较高,为7.1%.HER-2型乳腺癌确诊时肿块较大者所占比例较多,>5 cm者占l5.5%;淋巴结阳性者较多,占54.2%;病理分期较晚,Ⅲ期者达34.3%.Luminal型乳腺癌患者年龄偏大,≥35岁者占91.7%;确诊时病理分期较早,Ⅰ期者占20.4%.中位随访46个月时,Basal-like型、HER-2型和Luminal型乳腺癌患者的复发转移率分别为25.0%、27.9%和11.7%,Basal-like型和HER-2型乳腺癌患者的复发转移率显著高于Luminal型患者(P<0.001),Basal-1ike型与HER-2型乳腺癌患者的复发转移率差异无统计学意义,但Basal-like型乳腺癌患者肺转移发生率(13.4%)较高(P=0.017).Basal-1ike型、HER-2型和Luminal型乳腺癌患者的5年无病生存率(DFS)分别为72.2%、68.2%和86.2%(P<0.001),5年总生存率分别为88.6%、83.8%和95.8%(P<0.001).对全部1280例乳腺癌患者的多因素分析结果显示,肿瘤大小、淋巴结状况、激素受体状况、HER-2状况是乳腺癌患者预后的独立影响因素,患者的年龄仅是DFS的影响因素.分别对Basal-like型、HER-2型和Luminal型乳腺癌患者的多因素分析结果显示,肿瘤大小和淋巴结状况是影响各亚型乳腺癌患者预后的2个独立预后因素,年龄和内分泌治疗仅对HER-2型乳腺癌患者的DFS存在不良影响,HER-2状况依然是Luminal型乳腺癌患者预后的独立影响因素.结论 不同亚型乳腺癌具有特定的临床特征,肿瘤的复发模式和患者的生存情况亦因肿瘤亚型不同而存在差.
目的 分析Basal-like型、HER-2型和Luminal型乳腺癌患者的臨床特徵和預後,為乳腺癌的箇體化治療提供依據.方法 根據患者雌激素受體(ER)、孕激素受體(PR)和人錶皮生長因子受體2(HER-2)的免疫組化結果,將1280例可手術乳腺癌患者分為Basal-like型、HER-2型和Luminal型3組,迴顧性分析不同亞型乳腺癌的臨床特徵、複髮轉移及生存情況.結果 1280例乳腺癌患者中,Basal-like型、HER-2型和Luminal型乳腺癌分彆佔20.9%、23.2%和55.9%.Basal-like型乳腺癌年輕患者所佔比例較大,<35歲者佔13.4%;有乳腺癌傢族史者所佔比例較高,為7.1%.HER-2型乳腺癌確診時腫塊較大者所佔比例較多,>5 cm者佔l5.5%;淋巴結暘性者較多,佔54.2%;病理分期較晚,Ⅲ期者達34.3%.Luminal型乳腺癌患者年齡偏大,≥35歲者佔91.7%;確診時病理分期較早,Ⅰ期者佔20.4%.中位隨訪46箇月時,Basal-like型、HER-2型和Luminal型乳腺癌患者的複髮轉移率分彆為25.0%、27.9%和11.7%,Basal-like型和HER-2型乳腺癌患者的複髮轉移率顯著高于Luminal型患者(P<0.001),Basal-1ike型與HER-2型乳腺癌患者的複髮轉移率差異無統計學意義,但Basal-like型乳腺癌患者肺轉移髮生率(13.4%)較高(P=0.017).Basal-1ike型、HER-2型和Luminal型乳腺癌患者的5年無病生存率(DFS)分彆為72.2%、68.2%和86.2%(P<0.001),5年總生存率分彆為88.6%、83.8%和95.8%(P<0.001).對全部1280例乳腺癌患者的多因素分析結果顯示,腫瘤大小、淋巴結狀況、激素受體狀況、HER-2狀況是乳腺癌患者預後的獨立影響因素,患者的年齡僅是DFS的影響因素.分彆對Basal-like型、HER-2型和Luminal型乳腺癌患者的多因素分析結果顯示,腫瘤大小和淋巴結狀況是影響各亞型乳腺癌患者預後的2箇獨立預後因素,年齡和內分泌治療僅對HER-2型乳腺癌患者的DFS存在不良影響,HER-2狀況依然是Luminal型乳腺癌患者預後的獨立影響因素.結論 不同亞型乳腺癌具有特定的臨床特徵,腫瘤的複髮模式和患者的生存情況亦因腫瘤亞型不同而存在差.
목적 분석Basal-like형、HER-2형화Luminal형유선암환자적림상특정화예후,위유선암적개체화치료제공의거.방법 근거환자자격소수체(ER)、잉격소수체(PR)화인표피생장인자수체2(HER-2)적면역조화결과,장1280례가수술유선암환자분위Basal-like형、HER-2형화Luminal형3조,회고성분석불동아형유선암적림상특정、복발전이급생존정황.결과 1280례유선암환자중,Basal-like형、HER-2형화Luminal형유선암분별점20.9%、23.2%화55.9%.Basal-like형유선암년경환자소점비례교대,<35세자점13.4%;유유선암가족사자소점비례교고,위7.1%.HER-2형유선암학진시종괴교대자소점비례교다,>5 cm자점l5.5%;림파결양성자교다,점54.2%;병리분기교만,Ⅲ기자체34.3%.Luminal형유선암환자년령편대,≥35세자점91.7%;학진시병리분기교조,Ⅰ기자점20.4%.중위수방46개월시,Basal-like형、HER-2형화Luminal형유선암환자적복발전이솔분별위25.0%、27.9%화11.7%,Basal-like형화HER-2형유선암환자적복발전이솔현저고우Luminal형환자(P<0.001),Basal-1ike형여HER-2형유선암환자적복발전이솔차이무통계학의의,단Basal-like형유선암환자폐전이발생솔(13.4%)교고(P=0.017).Basal-1ike형、HER-2형화Luminal형유선암환자적5년무병생존솔(DFS)분별위72.2%、68.2%화86.2%(P<0.001),5년총생존솔분별위88.6%、83.8%화95.8%(P<0.001).대전부1280례유선암환자적다인소분석결과현시,종류대소、림파결상황、격소수체상황、HER-2상황시유선암환자예후적독립영향인소,환자적년령부시DFS적영향인소.분별대Basal-like형、HER-2형화Luminal형유선암환자적다인소분석결과현시,종류대소화림파결상황시영향각아형유선암환자예후적2개독립예후인소,년령화내분비치료부대HER-2형유선암환자적DFS존재불량영향,HER-2상황의연시Luminal형유선암환자예후적독립영향인소.결론 불동아형유선암구유특정적림상특정,종류적복발모식화환자적생존정황역인종류아형불동이존재차.
Objective To investigate the clinical characteristics and prognosis of patients with different subtypes of breast cancer: basaloid, HER-2 and luminal types, and try to find the evidence of individualized treatment for the patients. Methods 1280 histologically and immunohistochemically proven patients with resectable breast cancer were treated, and the clinical data including characteristics, relapse and survival of the patients with different subtypes of breast cancer were analyzed retrospectively. Results Of the1280 breast cancer patients, basaloid, HER-2 and luminal types accounted for 20.9%, 23.2% and 55.9%, respectively. Basaloid type was more likely to be found in younger patients frequently with a family history of breast cancer. HER-2 type usually had a tumor of larger size with more advanced stage disease and more metastatic lymph nodes. Luminal type was likely to occur in aged patients with an earlier stage disease. The recurrence rates in basaloid, HER-2 and luminal types were 25.0%, 27.9% and 11.7%, respectively. Patients with basaloid or HER-2 type were found to have a significantly higher recurrence rate than the patients with luminal type breast cancer (P<0.001), but no significant difference was observed between the basaloid and HER-2 types. However, patients with basaloid type breast cancer were more likely to develop lung metastasis than HER-2 type (13.4% vs. 7.1%, P=0.017). Up to December 2006, the 5-yeardisease-free survival (DFS) rates for patients with basaloid, HER-2 and luminal types were 72.2%, 68.2%and 86.2% (P<0.001), respectively. The overall 5-yr survival (OS) rates of the three groups were88.6%, 83.8% and 95.8% (P<0.001), respectively. Of the patients with luminal type breast cancer, HER2-negative patients had a higher DFS (86.2% vs 57.0%, P<0.001) and OS (95.8% vs 87.7%, P=0.0001) compared with those with HER2-positive. The results of Multivariate Cox Regression showed that tumor size and lymph node state were the most important factors influencing the prognosis. Conclusion Each sub type of breast cancer has somewhat its own specific clinical features in terms of recurrence pattern and prognosis, therefore, individualized treatment regimen may be required.
