人表皮生长因子受体-2在雌孕激素双阴性乳腺癌中的表达及作用

摘要

目的:研究三阴性乳腺癌和人表皮生长因子受体-2过表达型乳腺癌的临床病理特征,探讨多因素对雌激素(ER),孕激素(PR)双阴性乳腺癌预后的影响.方法:对本院2004年确诊并行手术治疗的1250例单侧乳腺癌进行回顾性分析,并通过免疫组化和FISH检测筛选三阴性乳腺癌和HER-2过表达型乳腺癌两种亚型,对两组患者在临床病理特征、复发转移部位、以及生存期进行分析.结果:中位随访60个月(6～73个月),两种亚型在发病年龄、月经状态、组织学分级、肿瘤大小和PCNA表达等方面组间差异均无统计学意义.三阴性乳腺癌患者中乳腺癌家族史患者比例(8.9%vs4.3%,P=0.010)和P53的阳性表达均较高(64.4%vs 60.7%,P=0.006);HER-2过表达型乳腺癌更易发生腋窝淋巴结转移,且淋巴结大于4枚以上的比例较高(36.6%vs29.7%,P=0.004),TNM分期Ⅲ期+Ⅳ期的患者比例比三阴性乳腺癌组高(18.3%vs 29.3%,P=0.014).两亚型乳腺癌在远处转移率和5年无病生存率相比较差异无统计学意义(P>0.05).结论:三阴性乳腺癌与HER-2过表达型乳腺癌在肿瘤临床病理特征方面有显著性差异,但短期(5年)无病生存率无显著性差异,因此推测HER-2不是ER,PR双阴性乳腺癌的短期生存的独立预后因素.%Objective: To compare the clinicopathologic characteristics and prognosis between triple negative breast cancer and other types of breast cancer that overexpress human epidermal growth factor receptor 2 (HER-2) and to investigate the prognostic factors of estrogen and progesterone receptor (ER, PR) negative breast cancer.Methods: A retrospective study of 1,250 female unilateral breast cancer patients undergoing surgery in our hospital in 2004 was performed.Patients with triple negative breast cancer and HER-2 overexpressing breast cancer were identified using immunohistochemistry and FISH.The clinicopathologic characteristics, recurrence and survival of the patients were summarized.Results: The median follow-up time was 60 months (range, 6-73 months).No significant difference was found between the phenotype and age, age at menopause, histological grade, or PCNA expression.Triple negative breast cancer patients had a higher percentage of breast cancer family history ( 8.9 & 4.3, P = 0.010 ) and P53 expression ( 64.4 & 60.7, P = 0.006 ).Patients with breast cancer overexpressing HER-2 experienced more lymph node metastasis and were more likely to have metastasis in more than 4 lymph nodes (36.6 & 29.7, P = 0.004 ).They also had a higher percentage of stage Ⅲ and Ⅳ disease (18.3& 29.3, P = 0.014 ).No significant difference in distant metastasis or 5-year disease-free survival was found between the two subtypes ( P ＞ 0.05 ).Conclusion: Patients with triple negative breast cancer exhibit many different clinical and histopathological features consistent with their specific biology and pathogenesis, and they have 5-year relapse and survival rates similar to patients with ER- and PR-negative, HER2 overexpressing breast cancer.Thus, it is proposed that HER-2 overexpression is not a prognostic factor for ER- and PR-negative breast cancers.