分子分型在早期乳腺癌复发、转移中的预测价值

摘要

目的：研究0－Ⅱb 期乳腺癌患者分子分型与局部复发、远处转移间的关系，为个体化治疗提供依据。方法：回顾分析2001年－2008年收治的临床分期为0－Ⅱb 期乳腺癌患者369例。根据免疫组织化学、荧光原位杂交检测技术结果分为 Luminal A、Luminal B、HER －2过表达和 Basal －like 型，比较局部复发率和远处转移率，并结合临床病理特征对其局部复发和远处转移进行分组分析。Kaplan －Meier 法计算局部复发率、远处转移率并 Logrank 法检验和单因素预后分析。结果：Luminal A、Luminal B、HER －2过表达和 Basal －like型分别占30．1％、48．5％、9．2％和12．2％。随访率95．4％，随访时间满5、10年者分别为225、85例。单因素分析显示 HER －2过表达型、Basal －like 型局部复发、远处转移风险均比 Luminal A、Luminal B 型高。5年局部复发率和远处转移率分别为23．5％、24．4％、6．3％、6．1％和26．5％、28．9％、2．7％、2．2％（P ＜0．001，P ＜0．001）。结论：分子分型有助于个体化区别早期乳腺癌患者间局部复发和远处转移的风险。%Objective:To investigate the relationship between molecular subtypes of breast cancer and postopera-tive local recurrence (LR)or distant metastasis (DM)in stage 0 -Ⅱb breast cancer patients ,and to provide the ba-sis of the individualized therapy.Methods:A total of 369 patients with stage 0 -Ⅱb breast cancer,who received com-prehensive treatment between January 2001 and June 2008,were retrospectively analyzed.The patients were divided into Luminal A group,Luminal B group,HER -2 -overexpressing group,and Basal -like group according to the mo-lecular subtypes of breast cancer determined by immunohistochemistry and fluorescence in situ hybridization.The pa-tients in different groups were compared in terms of LR rate (LRR)and DMrate (DMR),the risk factors for LR and DMwere analyzed in combination with clinical and pathological features.The Kaplan -Meier method was adopted to calculate LRR and DMR;the Logrank test was used for survival analysis and univariate prognostic analysis.Results:The Luminal A group,Luminal B group,HER -2 -overexpressing group,and Basal -like group accounted for 30.1%,48.5%,9.2% and 12.2%,respectively,of all the patients.The follow -up rate was 95.4%;225 patients were followed up for over 5 years,and 85 were followed up for over 10 years.Univariate analysis showed that,the HER-2 -overexpressing group,Basal -like group had significantly higher 5 -year LRRs and DMRs than the Luminal A group,Luminal B group.The LRR and DMR of these groups were 23.5%,24.4%,6.3%,6.1% and 26.5%, 28.9%,2.7%,2.2%(P <0.001 and P <0.001).Conclusion:Molecular subtyping is helpful for individualized e-valuation of LR and DMrisk in stage 0 -Ⅱb breast cancer patients.