目的

研究乳腺导管原位癌(DCIS) 的组织学级别及各分子分型与临床病理特征之间的关系。

方法

收集2005 年1 月至2016 年1 月广东省妇幼保健院收治的240 例DCIS 患者的手术标本进行回顾性研究,应用免疫组织化学方法检测ER、PR、HER-2 和Ki67 的表达,并根据结果对所有病例进行分子分型。 分析不同级别及不同分子分型DCIS 患者的临床病理特征。 年龄及组织学分级比较采用非参数检验(Kruskal-Wallis H 检验),其余指标比较采用χ² 检验。 ER、PR、HER-2 表达的两两比较用χ² 分割法。

结果

在全部240 例患者中, 低级别DCIS 有74 例(30.8%),中级别DCIS 139 例(57.9%), 高级别DCIS 27 例(11.3%);luminal A 型92 例(38.3%),luminal B 型70 例(29.2%),HER-2过表达型76 例(31.7%),三阴型2 例(0.8%)。 不同级别DCIS 患者年龄分布的差异无统计学意义(χ²=5.224,P=0.073),但ER、PR 及HER-2 表达的差异均有统计学意义(χ²=62.974、59.391、58.501,P 均<0.001)。 两两比较结果显示,ER、PR 在低级别DCIS 中的表达均高于中级别和高级别DCIS (ER:χ²=36.345、67.769,P 均<0.014;PR: χ² =41.172、51.440,P 均<0.014);HER-2 在高级别DCIS 中的表达高于中、低级别的DCIS(χ²=6.391、50.132,P 均<0.014)。 不同分子分型患者的年龄分布及患侧差异无统计学意义(χ²=0.811、4.332,P=0.847、0.228),但是组织学分级差异有统计学意义(χ² =80.779,P<0.001)。 组织学分级在luminal A 型分别与luminal B 型、HER-2 过表达型、三阴型比较,luminal B 型与HER-2 过表达型比较时,差异均有统计学意义(P 均<0.050)。

结论

检测DCIS 的分子分型,可为临床诊疗及预后预测提供参考。

Objective

To study the relationship of different histological grades and molecular subtypes with clinicopathological characteristics in breast ductal carcinoma in situ (DCIS) patients.

Methods

The surgical specimens from 240 patients with DCIS in Guangdong Women and Children's Hospital from January 2001 to January 2016 were collected for a retrospective study. The expressions of ER, PR, HER-2 and Ki67 were detected by immunohistochemistry. Based on the results, all patients were divided into 4 molecular subtypes. The clinicopathological characteristics of DCIS patients were analyzed according to different histological grades and molecular subtypes. The data on age and histological grade were compared by nonparametric test (Kruskal-Wallis H test), and the other indexes were analyzed by χ² test. χ² segmentation was used for pairwise comparison in ER, PR and HER-2 expression.

Results

Among the 240 patients, there were 74 cases (30.8%) of low-grade DCIS, 139 cases (57.9%) of middle-grade DCIS and 27 cases(11.3%) of high-grade DCIS. There were 92 cases (38.3%) of luminal A subtype, 70 cases (29.2%) of luminal B subtype, 76 cases (31.7%) of HER-2-overexpressed subtype and 2 cases (0.8%) of triplenegative subtype. The age distribution showed no significant difference in DCIS patients at different histological grades (χ²=5.224,P=0.073), but there were significant differences in ER, PR and HER-2 expressions(χ²=62.974,59.391,58.501; all P<0.001). The results of pairwise comparison showed that the expression of ER/PR in low-grade DCIS was significantly higher than that in middle-grade or high-grade DCIS (ER: χ²=36.345,67.769,both P<0.014;PR: χ²=41.172, 51.440,both P<0.014), while the expression of HER-2 in high-grade DCIS was significantly higher than that in middle-grade or low-grade DCIS(χ²=6.391,50.132,both P<0.014). There was no significant difference in age distribution and affected side among patients with different molecular subtypes (χ²=0.811,4.332; P=0.847,0.228), while the histological grade showed a significant difference(χ²=80.779,P<0.001). The histological grades were significantly different comparing luminal A subtype with luminal B, HER-2-overexpressed and triple-negative subtypes respectively (all P<0.050). The histological grade of luminal B subtype was significantly different from that of HER-2-overexpressed subtype (P<0.050).

Conclusion

The molecular typing can be used as a reference for clinical diagnosis and prognosis prediction in DCIS patients.