CAJ | 학술논문

背景与目的：根据肿瘤的分子标志物不同，乳腺癌可以被分为几种亚型。不同亚型转移模式的区别对患者治疗方式的选择有很大临床意义，但目前探讨较少。该研究探讨了不同分子亚型的乳腺癌易首发转移的部位以及时间。方法：1998—2004年间在中山市人民医院接受手术治疗的早期原发性浸润性乳腺癌患者共390例纳入该研究。肿瘤分为Luminal A、Luminal B、HER-2过表达型和三阴性型4种亚型。随访这些患者，记录初次远处转移部位及时间，采用Kaplan-Meier法进行生存分析。结果：390例患者中，Luminal A型215例(55.1%)、三阴性型80例(20.5%)、HER-2型52例(13.3%)、Luminal B型43例(11.0%)。中位随访118个月(11～163个月)，72例(18.5%)出现远处转移：其中Luminal A型37例，Luminal B型8例，HER-2过表达型10例和三阴性型17例。骨是最常见的首次转移部位(39/72，54.2%)，其次是肺(25/72，34.7%)、肝(22/72，30.6%)、脑(7/72，9.7%)。Luminal型(Luminal A型70.2%，Luminal B型50.0%)患者的骨转移比例显著高于HER-2过表达型(30.0%)及三阴性型(35.3%)乳腺癌(P=0.03)。Luminal B型(37.5%)和三阴性(17.6%)乳腺癌的脑转移比例显著高于Luminal A型和HER-2过表达型(P＝0.01)。生存分析显示不同亚型乳腺癌的9年无远处转移生存率差异无统计学意义，但是HER-2过表达型和三阴性型乳腺癌转移出现显著早于Luminal型乳腺癌。结论：不同亚型乳腺癌的初次远处转移模式不同。Luminal型转移出现较早、易发生骨转移；三阴性乳腺癌和Luminal B型乳腺癌转移出现较晚，并易发生脑转移。
배경여목적：근거종류적분자표지물불동，유선암가이피분위궤충아형。불동아형전이모식적구별대환자치료방식적선택유흔대림상의의，단목전탐토교소。해연구탐토료불동분자아형적유선암역수발전이적부위이급시간。방법：1998—2004년간재중산시인민의원접수수술치료적조기원발성침윤성유선암환자공390례납입해연구。종류분위Luminal A、Luminal B、HER-2과표체형화삼음성형4충아형。수방저사환자，기록초차원처전이부위급시간，채용Kaplan-Meier법진행생존분석。결과：390례환자중，Luminal A형215례(55.1%)、삼음성형80례(20.5%)、HER-2형52례(13.3%)、Luminal B형43례(11.0%)。중위수방118개월(11～163개월)，72례(18.5%)출현원처전이：기중Luminal A형37례，Luminal B형8례，HER-2과표체형10례화삼음성형17례。골시최상견적수차전이부위(39/72，54.2%)，기차시폐(25/72，34.7%)、간(22/72，30.6%)、뇌(7/72，9.7%)。Luminal형(Luminal A형70.2%，Luminal B형50.0%)환자적골전이비례현저고우HER-2과표체형(30.0%)급삼음성형(35.3%)유선암(P=0.03)。Luminal B형(37.5%)화삼음성(17.6%)유선암적뇌전이비례현저고우Luminal A형화HER-2과표체형(P＝0.01)。생존분석현시불동아형유선암적9년무원처전이생존솔차이무통계학의의，단시HER-2과표체형화삼음성형유선암전이출현현저조우Luminal형유선암。결론：불동아형유선암적초차원처전이모식불동。Luminal형전이출현교조、역발생골전이；삼음성유선암화Luminal B형유선암전이출현교만，병역발생뇌전이。
Background and purpose:Breast cancer can be divided into several molecular subtypes according to its biomarkers. The pattern of distant metastasis has a great clinic significance but was rarely investigated. This study investigated the impact of molecular subtype of breast cancer on initial sites of metastasis..Methods:All the patients with operable invasive breast cancer diagnosed in Zhongshan People’s Hospital between 1998 and 2004 were recruited. Subtypes were defined as Luminal A, Luminal B, human epidermal growth factor receptor 2 (HER-2) enriched, and triple negative (TN) according to the expression of estrogen receptor (ER), progestogen receptor (PR) and HER-2 status. The first distant metastatic sites and the time of their appearances were recorded. Survival curves were constructed using the Ka-plan-Meier technique.Results:Among 390 eligible patients, there were 215(55.1%) with Luminal A, 43 (11.0%) with Lu-minal B, 52 (13.3%) with HER-2 enriched, and 80 (20.5%) with TN. The median follow-up time was 118 months (11-163 months). Seventy-two (18.5%) distant metastases occurred during follow-up: 37 metastases in Luminal A, 8 in Luminal B, 10 in HER-2, 17 in TN. Bone was the most common site of the first distant metastasis (39/72, 54.2%) followed by lung (25/72, 34.7%), liver (22/72, 30.6%), and brain (7/72, 9.7%). Among all the metastases, tumors of Luminal type (Luminal A 70.2%, Luminal B 50.0%) had a higher chance of bone involvement than that of HER-2 enriched (30.0%) and TN (35.3%,P=0.03). Both Luminal B (37.5%) and TN (17.6%) subtypes had a higher percentage of brain involvement than Luminal A and HER-2 enriched (P=0.01). The survival analysis showed no significant difference among the four subtypes in 9-year distant metastasis-free survival. However, distant metastasis appeared earlier in HER-2 enriched and TN breast cancer than in Luminal type.Conclusion:Organ-specific metastasis may depend on the molecular subtype of breast cancer. Bone metastasis occurs more in luminal type than in other types. Luminal B and TN types of tumors had more chance of brain metastasis than Luminal A and HER-2 enriched type of tumors.