乳腺癌分子分型与预后关系的研究

摘要

目的 探讨乳腺癌分子分型与预后之间的关系.方法 回顾性分析2002年1月至2003年12月接受手术治疗的708例原发性乳腺癌患者的临床资料.患者均为女性,平均年龄53岁.根据雌激素受体(ER)、孕激素受体(PR)及人类表皮生长因子受体2(HER2)状态的免疫组织化学结果,将全组乳腺癌分型为:内分泌高反应型、内分泌反应不完全型、三阴型及HER2阳性型,观察不同分子分型乳腺癌的预后,比较各型患者术后的累计生存率,多因素分析筛选预后相关因素.结果 本组内分泌高反应型、内分泌反应不完全型、HER2阳性型及三阴型乳腺癌所占的比例分别为33.2%(235/708)、23.6%(167/708)、21.3%(151/708)和21.9%(155/708).随访3～69个月,中位随访时间40.2个月,100例患者复发或死亡.单因素分析示乳腺癌预后与肿瘤大小、腋窝淋巴结状态、分子分型、术后辅助放疗及内分泌治疗有关;多因素分析示分子分型和淋巴结状态为乳腺癌的独立预后因素;生存分析示内分泌高反应型乳腺癌的预后好于其他三型.结论 乳腺癌分子分型是预后的独立预测因素,内分泌高反应型乳腺癌预后最好.%Objective To investigate the relationship between breast cancer molecular classification and prognosis.Methods From January 2002 to December 2003,708 female primary breast cancer patients with a mean age of 53 years old were retrospectively ana lyzed.The classification of breast cancer was according to the immunohistochemical results of estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor(HER2)status.Molecular classification definitions included highly endocrine responsive,incompletely endocrine responsive,triple negative,and HER2 positive.The prognosis among difierent molecular classifications of breast cancer was investigated.The survival rates of different classifations were compared by Log-rank test.Results The proportion of highly endocrine responsive,incompletely endocrine responsive,HER2 positive and triple-negative breast cancer was 33.2%(235/708),23.6%(167/708),21.3%(151/708)and 21.9%(155/708).The follow-up period were from 3 to 68 months with a median of 40.2 months.A total of 100 Cases were identified to had disease recurrence or death Factors affecting the prognosis were tumor size,axillary lymph node status,molecular classification,adjuvant radiotherapy and adjuvant endocnne therapy by univariate analysis.Multivariate analysis revealed that the molecular classification and lymph node status were the independent prognostic factors with the hazard ratio 1.205(P=0.047)and 4.512(P=0.000),respectively.Survival analysis showed that highly endocrine responsive breast cancer was with superior prognosis versus others.Conclusions Molecular classification of breast cancer is an independent predictor of prognosis.Breast cancer patients classified as highly endocrine responsive subtype have the best outcome.