协和医学杂志
協和醫學雜誌
협화의학잡지
MEDICAL JOURNAL OF PEKING UNION MEDICAL COLLEGE HOSPITAL
2015年
1期
1-8
,共8页
袁礼%吴焕文%任新瑜%梁智勇
袁禮%吳煥文%任新瑜%樑智勇
원례%오환문%임신유%량지용
三阴乳腺癌%雌激素受体β%表皮生长因子受体%临床病理特征%预后
三陰乳腺癌%雌激素受體β%錶皮生長因子受體%臨床病理特徵%預後
삼음유선암%자격소수체β%표피생장인자수체%림상병리특정%예후
triple negative breast cancer%estrogen receptor β%epidermal growth factor receptor%clinicopathological fea-tures%prognosis
目的:比较三阴乳腺癌与非三阴乳腺癌在临床病理特征及部分免疫组织化学指标表达上的差异,并探讨这些免疫组织化学指标的表达与三阴乳腺癌临床病理特征及预后的关系。方法2010年1月至2013年12月北京协和医院收治的经组织病理确诊的乳腺癌患者共863例,其中三阴乳腺癌患者135例,非三阴乳腺癌患者728例。分析三阴乳腺癌与非三阴乳腺癌患者在发病年龄、病理类型、肿瘤大小、分化程度、肿瘤分期、是否有淋巴结转移、是否累及乳头以及手术方式等临床病理特征方面的差异。通过免疫组织化学法检测135例三阴乳腺癌患者与经单纯抽样法选取的135例非三阴乳腺癌患者中雌激素受体β(estrogen receptor β, ERβ)、表皮生长因子受体(epidermal growth factor receptor, EGFR)、 P53、Ki67的表达,分析上述指标在两类乳腺癌中的表达差异。进一步通过单因素生存分析探讨三阴乳腺癌患者的预后相关因素。结果三阴乳腺癌中浸润性导管癌的比例高于非三阴乳腺癌(86.7%比65.2%, P<0.001),发病年龄低于非三阴乳腺癌[(46.0±10.6)岁比(51.0±13.3)岁, P<0.05];三阴乳腺癌与非三阴乳腺癌在淋巴结转移、临床分期、肿瘤大小、分化程度、手术方式方面差异亦有统计学意义( P<0.05);三阴乳腺癌与非三阴乳腺癌在肿瘤累及乳头的比例差异无统计学意义(P>0.05)。免疫组织化学结果显示,三阴乳腺癌中ERβ阳性表达率较非三阴乳腺癌显著降低(63.7%比75.6%, P<0.05),而EGFR阳性表达率显著升高(62.2%比33.3%, P<0.05); P53、 Ki67在三阴乳腺癌与非三阴乳腺癌中的表达差异无统计学意义(P>0.05)。与非三阴乳腺癌相比,三阴乳腺癌的总体生存率(overall survival, OS)和无复发生存率(relapse-free survival, RFS)更低(P<0.05)。三阴乳腺癌单因素生存分析结果显示, ERβ阴性表达与EGFR阳性表达均与三阴乳腺癌的不良预后相关( P<0.05)。结论相较于非三阴乳腺癌,三阴乳腺癌有明显不同的临床病理特征:发病年龄较低、原发肿瘤体积较大、分化程度低、易发生淋巴结转移、 ERβ阳性表达率较低、 EGFR阳性表达率较高、 OS及RFS较低。 ERβ和EGFR可能成为重要的三阴乳腺癌预后判断指标。
目的:比較三陰乳腺癌與非三陰乳腺癌在臨床病理特徵及部分免疫組織化學指標錶達上的差異,併探討這些免疫組織化學指標的錶達與三陰乳腺癌臨床病理特徵及預後的關繫。方法2010年1月至2013年12月北京協和醫院收治的經組織病理確診的乳腺癌患者共863例,其中三陰乳腺癌患者135例,非三陰乳腺癌患者728例。分析三陰乳腺癌與非三陰乳腺癌患者在髮病年齡、病理類型、腫瘤大小、分化程度、腫瘤分期、是否有淋巴結轉移、是否纍及乳頭以及手術方式等臨床病理特徵方麵的差異。通過免疫組織化學法檢測135例三陰乳腺癌患者與經單純抽樣法選取的135例非三陰乳腺癌患者中雌激素受體β(estrogen receptor β, ERβ)、錶皮生長因子受體(epidermal growth factor receptor, EGFR)、 P53、Ki67的錶達,分析上述指標在兩類乳腺癌中的錶達差異。進一步通過單因素生存分析探討三陰乳腺癌患者的預後相關因素。結果三陰乳腺癌中浸潤性導管癌的比例高于非三陰乳腺癌(86.7%比65.2%, P<0.001),髮病年齡低于非三陰乳腺癌[(46.0±10.6)歲比(51.0±13.3)歲, P<0.05];三陰乳腺癌與非三陰乳腺癌在淋巴結轉移、臨床分期、腫瘤大小、分化程度、手術方式方麵差異亦有統計學意義( P<0.05);三陰乳腺癌與非三陰乳腺癌在腫瘤纍及乳頭的比例差異無統計學意義(P>0.05)。免疫組織化學結果顯示,三陰乳腺癌中ERβ暘性錶達率較非三陰乳腺癌顯著降低(63.7%比75.6%, P<0.05),而EGFR暘性錶達率顯著升高(62.2%比33.3%, P<0.05); P53、 Ki67在三陰乳腺癌與非三陰乳腺癌中的錶達差異無統計學意義(P>0.05)。與非三陰乳腺癌相比,三陰乳腺癌的總體生存率(overall survival, OS)和無複髮生存率(relapse-free survival, RFS)更低(P<0.05)。三陰乳腺癌單因素生存分析結果顯示, ERβ陰性錶達與EGFR暘性錶達均與三陰乳腺癌的不良預後相關( P<0.05)。結論相較于非三陰乳腺癌,三陰乳腺癌有明顯不同的臨床病理特徵:髮病年齡較低、原髮腫瘤體積較大、分化程度低、易髮生淋巴結轉移、 ERβ暘性錶達率較低、 EGFR暘性錶達率較高、 OS及RFS較低。 ERβ和EGFR可能成為重要的三陰乳腺癌預後判斷指標。
목적:비교삼음유선암여비삼음유선암재림상병리특정급부분면역조직화학지표표체상적차이,병탐토저사면역조직화학지표적표체여삼음유선암림상병리특정급예후적관계。방법2010년1월지2013년12월북경협화의원수치적경조직병리학진적유선암환자공863례,기중삼음유선암환자135례,비삼음유선암환자728례。분석삼음유선암여비삼음유선암환자재발병년령、병리류형、종류대소、분화정도、종류분기、시부유림파결전이、시부루급유두이급수술방식등림상병리특정방면적차이。통과면역조직화학법검측135례삼음유선암환자여경단순추양법선취적135례비삼음유선암환자중자격소수체β(estrogen receptor β, ERβ)、표피생장인자수체(epidermal growth factor receptor, EGFR)、 P53、Ki67적표체,분석상술지표재량류유선암중적표체차이。진일보통과단인소생존분석탐토삼음유선암환자적예후상관인소。결과삼음유선암중침윤성도관암적비례고우비삼음유선암(86.7%비65.2%, P<0.001),발병년령저우비삼음유선암[(46.0±10.6)세비(51.0±13.3)세, P<0.05];삼음유선암여비삼음유선암재림파결전이、림상분기、종류대소、분화정도、수술방식방면차이역유통계학의의( P<0.05);삼음유선암여비삼음유선암재종류루급유두적비례차이무통계학의의(P>0.05)。면역조직화학결과현시,삼음유선암중ERβ양성표체솔교비삼음유선암현저강저(63.7%비75.6%, P<0.05),이EGFR양성표체솔현저승고(62.2%비33.3%, P<0.05); P53、 Ki67재삼음유선암여비삼음유선암중적표체차이무통계학의의(P>0.05)。여비삼음유선암상비,삼음유선암적총체생존솔(overall survival, OS)화무복발생존솔(relapse-free survival, RFS)경저(P<0.05)。삼음유선암단인소생존분석결과현시, ERβ음성표체여EGFR양성표체균여삼음유선암적불량예후상관( P<0.05)。결론상교우비삼음유선암,삼음유선암유명현불동적림상병리특정:발병년령교저、원발종류체적교대、분화정도저、역발생림파결전이、 ERβ양성표체솔교저、 EGFR양성표체솔교고、 OS급RFS교저。 ERβ화EGFR가능성위중요적삼음유선암예후판단지표。
Objective To analyze the differences in clinicopathologic features and expressions of some im -munohistochemical indicators between triple negative breast cancer and non -triple negative breast cancer , and to investigate the relationship between clinicopathological features and immunohistochemical indicators .Methods A total of 863 patients (135 triple negative breast cancer and 728 non-triple negative breast cancer ) with his-topathologically confirmed breast cancer were collected in Peking Union Medical College Hospital from January 2010 to December 2013 .We retrospectively analyzed the difference in the onset age , histological subtype , tumor size, tumor differentiation, tumor stages, lymph node metastasis, nipple involvement and operation method be-tween triple negative breast cancer and non-triple negative breast cancer , then explored the difference between them in the expressions of estrogen receptor β(ERβ), epidermal growth factor receptor (EGFR), P53, and Ki67 by immunohistochemical staining .Prognostic factors of triple negative breast cancer were further discussed by univariate survival analysis .Results The proportion of invasive ductal carcinoma in triple negative breast cancer was higher than that in non-triple negative breast cancer ( 86.7% vs.65.2%, P<0.001 ); the age of onset was younger in triple negative breast cancer [(46.0 ±10.6) years vs.(51.0 ±3.3) years, P<0.05];significant differences were also found in lymph node metastasis , tumor size , differentiation grade , surgical proce-dure, and tumor stages between the two groups (P<0.05);no statistically significant inter-group difference in nipple involvement ( P >0.05 ) .Immunohistochemical results showed that compared with non-triple negative breast cancer , ERβexpression rate decreased significantly ( 63.7% vs.75.6%, P <0.05 ) while EGFR expression rate increased significantly in triple negative breast cancer ( 62.2% vs.33.3%, P <0.05 ); the expression of P53 and Ki67 demonstrated no significant difference (P>0.05).The overall survival (OS) and relapse-free survival ( RFS) were both lower in triple negative breast cancer ( P<0.05 ) .Univariate survival analysis showed that both ERβnegative expression and EGFR positive expression were related to the poor progno -sis of triple negative breast cancer ( P<0.05 ) .Conclusions Compared with non-triple negative breast cancer , triple negative breast cancer shows completely different clinicopathological features :younger age of onset , larger tumor size , lower degree of differentiation , higher incidence of lymph node metastasis , lower ERβexpression , higher EGFR expression , and lower OS and RFS .ERβand EGFR may be important prognostic indicators in tri-ple negative breast cancer .