切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2009, Vol. 03 ›› Issue (02) : 139 -146. doi: 10.3877/cma.j.issn.1674-0807.2009.02.003

临床研究

乳腺癌不同分子亚型的临床特点和生存分析
连臻强1, 何洁华2, 王曦2, 唐军2, 杨名添2,()   
  1. 1.510010 广州,广东省妇幼保健院乳腺病中心
    2.510060 广州,中山大学肿瘤防治中心乳腺科华南肿瘤学国家重点实验室
  • 收稿日期:2009-01-09 出版日期:2009-04-01
  • 通信作者: 杨名添

Clinical features and survival analysis of molecular subtyping of breast cancer

Zhen-qiang LIAN1, Jie-Hua HE1, Xi WANG1, Jun TANG1, Ming-tian YANG,1()   

  1. 1.Department of Breast Surgery,Cancer Center of Sun Yet-Sen University &State Key Laboratory of Oncology in Southern China,Guangzhou 510060,China
  • Received:2009-01-09 Published:2009-04-01
  • Corresponding author: Ming-tian YANG
引用本文:

连臻强, 何洁华, 王曦, 唐军, 杨名添. 乳腺癌不同分子亚型的临床特点和生存分析[J/OL]. 中华乳腺病杂志(电子版), 2009, 03(02): 139-146.

Zhen-qiang LIAN, Jie-Hua HE, Xi WANG, Jun TANG, Ming-tian YANG. Clinical features and survival analysis of molecular subtyping of breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2009, 03(02): 139-146.

目的

探讨乳腺癌各分子亚型的临床特点及其预后情况。

方法

回顾性分析482例可手术乳腺癌患者资料,以免疫组织化学技术为基础,把乳腺癌分为4种分子亚型:luminal A 型[ER(+)或PR(+)且HER-2(-)],luminal B型[ER(+)或PR(+)且HER-2(+)],HER-2过表达型[ER(-)、PR(-)且HER-2(+)]和basal-like 型[ER(-)、PR(-)且HER-2(-)],并分析其临床特点及预后情况。

结果

全组共482例,其中luminal A型占46.1%(222/482),luminal B型占14.7%(71/482),HER-2过表达型占10.4%(50/482),basallike型占28.8%(139/482)。运用χ2检验各分子亚型在年龄、月经状况、肿瘤大小、淋巴结状况和临床分期等的差异均无统计学意义。全组有完整随访资料者共441例,中位随访时间62个月。随访结果显示,HER-2过表达型和basal-like型的远处转移率均高于luminal A 型,且差异有统计学意义(χ2=11.659,P=0.009);运用Kaplan-Meier法分析各分子亚型的生存预后,luminal A 型的无病生存率、无远处转移生存率和总生存率最高,HER-2过表达型和basal-like型的预后最差,差异有统计学意义(Log-Rank 检验,P 均<0.050)。

结论

乳腺癌分子分型对患者预后的判断具有重要临床意义,有望成为今后制定乳腺癌个体化治疗的重要依据。

Objective

To analyze the clinical features and survival of molecular subtyping in breast cancer patients.

Methods

A total of 482 cases of operable breast cancer were analyzed retrospectively.Molecular subtypes,based on immunohistochemistry,were categorized as follows:luminal A [ER(+)or PR(+)/HER-2(-)],luminal B[ER(+)or PR(+)/HER-2(+)],HER-2(+)subtype[ER(-),PR(-)/HER-2(+)],and basal-like subtype[ER(-),PR(-)/HER-2(-)].The clinical features and prognostic status were analyzed.

Results

Among the 482 cases,222 cases(46.1%)were luminal A,71(1.7%)were luminal B,50(10.4%)were HER-2(+)subtype,and 139(28.8%)were basal-like subtype.The molecular subtypes did not differ in age,menopausal status,tumor size,node status and TNM stage.Of the 482 cases,441 had complete follow-up data,the median follow-up time was 62 months,ranging 36-88 months.Distant metastatic rates of HER-2(+)subtype and basal-like subtype were higher than that of luminal A,with statistically significant difference(χ2=11.659,P=0.009).Kaplan-Meier analysis showed DFS,DDFS and OS were the hig-hest for luminal A and were poor for HER-2(+)subtype and basal-like subtype,with statistically significant difference(Log-Rank test,P<0.050).

Conclusions

Molecular subtyping could provide important information to predict the prognosis of breast cancer and might be the important basis for individual treatment of breast cancer in future.

图1 HER-2基因在乳腺癌组织的表达(CISH ×400) a:无扩增;b:低拷贝扩增;c:高拷贝扩增
表1 482例乳腺癌各分子亚型的临床病理特点
表2 441例乳腺癌各分子亚型的复发转移情况
图2 各分子亚型乳腺癌患者的无病生存曲线
图3 各分子亚型乳腺癌患者的无远处转移生存曲线
图4 各分子亚型乳腺癌患者的总生存曲线
[1]
Carey L A,Perou C M,Livasy C A,et al.Race,breast cancer subtypes,and survival in the Carolina Breast Cancer Study.JAMA,2006,295:2492-2502.
[2]
Perou C M,Sørlie T,Eisen M B,et al.Molecular portraits of human breast tumours.Nature,2000,406:747-752.
[3]
Sorlie T,Perou C M,Tibshirani R,et al.Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications.Proc Natl Acad Sci USA,2001,98:10 869-10 874.
[4]
Sorlie T,Tibshirani R,Parker J,et al.Repeated observation of breast tumor subtypes in independent gene expression data sets.Proc Natl Acad Sci USA,2003,100:8418-8423.
[5]
Ihemelandu C U,Leffall L D Jr,Dewitty R L,et al.Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women:age-specific prevalence and survi-val.J Surg Res,2007,143:109-118.
[6]
Adebamowo C A,Famooto A,Ogundiran T O,et al.Immunohistochemical and molecular subtypes of breast cancer in Nigeria.Breast Cancer Res Treat,2008,110:183-188.
[7]
Dent R,Trudeau M,Pritchard K I,et al.Triple-negative breast cancer:clinical features and patterns of recurrence.Clin Cancer Res,2007,13:4429-4434.
[8]
Ihemelandu C U,Naab T J,Mezghebe H M,et al.Basal cell-like(triple-negative)breast cancer,a predictor of distant metastasis in African American women.Am J Surg,2008,195:153-158.
[9]
Haffty B G,Yang Q,Reiss M,et al.Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer.J Clin Oncol,2006,24:5652-5657.
[10]
Bauer K R,Brown M,Cress R D,et al.Descriptive analysis of estrogen receptor(ER)-negative,progesterone receptor(PR)-negative,and HER-2-negative invasive breast cancer,the so-called triple-negative phenotype:a population-based study from the California cancer Registry.Cancer,2007,109:1721-1728.
[11]
Smith I,Procter M,Gelber R D,et al.2-year follow-up of trastuzumab after adjuvant chemotherapy in HER-positive breast cancer:a randomized controlled trial.Lancet,2007,369:29-36.
[12]
Romond E H,Perez E A,Bryant J,et al.Trastuzumab plus adjuvant chemotherapy for operable HER-2-positive breast cancer.N Engl J Med,2005,353:1673-1684.
[13]
Bertucci F,Finetti P,Cervera N,et al.How basal are triple-negative breast cancers?Int J Cancer,2008,123:236-240.
[14]
Carey L A,Dees E C,Sawyer L,et al.The triple negative paradox:primary tumor chemosensitivity of breast cancer subtypes.Clin Cancer Res,2007,13:2329-2334.
[1] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[2] 周荷妹, 金杰, 叶建东, 夏之一, 王进进, 丁宁. 罕见成人肋骨郎格汉斯细胞组织细胞增生症被误诊为乳腺癌术后骨转移一例[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 380-383.
[3] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[4] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[5] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[6] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[7] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[8] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[9] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[10] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[11] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[12] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[13] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要