无腋淋巴结转移乳腺癌患者孕激素受体检测的预后价值

摘要

Objective　To study the effect of progesterone receptor (PR) status on the prognosis of breast cancer with negative axillary lymph nodes (NL).　Methods　PR status was immunohistochemically examined in the specimens of 128 NL and 266 breast cancer patients with positive axillary lymph nodes (PL) who were operated on from April 1985 to August 1992, and followed up.　Results　126 of 128 NL breast cancer patients (98.4%) were followed up from 90 to 174 months, with 110.9 months on average. The positive rate of PR in NL breast cancer (53.1%) was significantly higher than that of PL breast cancer (31.2%) (χ2=17.57, P＜0.01). A totall of 24 cases suffered from relapse or metastasis, the recurrent rate of PR(+) group (10.3%) was significantly lower than that of PR(-) group (28.3%) (χ2=5.80, P＜0.05). In PR (+) and PR (-) group, the 5-year survial rates were 95.5% and 88.1% (χ2=2.34,P＞0.05), the 10-year survival rates 80.0% and 65.5% (χ2=1.40,P＞0.05), and the 7-year-death rates were 4.4% and 16.7% respectively (χ2=5.24,P＜0.05).　Conclusion　PR in NL breast cancer is an important prognostic factor, the recurrent rate as well as the 7-year-death rate in the PR (-) group is significantly higher than that of the PR (+) group. If easily metastatizes to visceral organs, and the 5-year and 10-year survival rates of the PR (-) group are also lower than those of PR (+) group. As to NL breast cancer patients, when PR is negative, we should actively make any auxiliary treatment apart from chemotherapy to increase their therapeutic effect.%目的探讨孕激素受体（PR）水平对腋淋巴结阴性（NL）乳腺癌患者预后的影响。方法对手术治疗的128例NL和266例腋淋巴结转移（PL）的乳腺癌患者，用免疫组化法检测标本的PR状况，并随访。结果 128例NL乳腺癌患者随访126例，占98.4%，随访时间90.0～174.0个月，平均110.9个月。128例NL乳腺癌PR检测阳性68例，阳性率为53.1%，同期266例PL乳腺癌PR阳性83例，阳性率为31.2%，二者的差异有非常显著性意义（χ2=17.57，P＜0.01）。NL乳腺癌发生转移和复发24例，PR阳性和阴性组的复发率分别为10.3%和28.3%，二者的差异有显著性意义（χ2=5.24，P＜0.05）；5年生存率分别为95.5%和88.1%（χ2=2.34，P＞0.05）；10年生存率分别为80.0%和65.5%(χ2=1.40，P＞0.05)；7年病死率分别为4.4%和16.7%（χ2=5.24，P＜0.05）,二者差异有显著性意义。结论 NL乳腺癌的PR是影响预后的重要因素，PR阴性组乳腺癌复发转移明显高于PR阳性组，且易转移至内脏，其7年病死率明显高于PR阳性组，5年和10年生存率也低于PR阳性组。故对NL乳腺癌，当PR阴性时，应积极施行包括化疗在内的辅助治疗以提高疗效。