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中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 353 -359. doi: 10.3877/cma.j.issn.1674-0807.2022.06.004

论著

雄激素受体在乳腺癌组织中的表达及其影响因素
王娅1, 张艾佳1, 赵梓岐1, 汪菲1, 牟国煜1, 蔡振刚1, 王洪江1,()   
  1. 1. 116011 大连医科大学附属第一医院乳腺外科
  • 收稿日期:2022-07-11 出版日期:2022-12-01
  • 通信作者: 王洪江

Expression of androgen receptor in breast cancer tissue and its influencing factors

Ya Wang1, Aijia Zhang1, Ziqi Zhao1, Fei Wang1, Guoyu Mu1, Zhengang Cai1, Hongjiang Wang1,()   

  1. 1. Department of Breast Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
  • Received:2022-07-11 Published:2022-12-01
  • Corresponding author: Hongjiang Wang
引用本文:

王娅, 张艾佳, 赵梓岐, 汪菲, 牟国煜, 蔡振刚, 王洪江. 雄激素受体在乳腺癌组织中的表达及其影响因素[J/OL]. 中华乳腺病杂志(电子版), 2022, 16(06): 353-359.

Ya Wang, Aijia Zhang, Ziqi Zhao, Fei Wang, Guoyu Mu, Zhengang Cai, Hongjiang Wang. Expression of androgen receptor in breast cancer tissue and its influencing factors[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(06): 353-359.

目的

探索雄激素受体(AR)在乳腺癌组织中的表达及其影响因素。

方法

回顾性分析大连医科大学附属第一医院2016年4月至2019年11月收治的972例原发性乳腺癌患者资料,根据AR表达情况分为AR阳性组及AR阴性组,其中AR阳性组患者根据AR阳性细胞的比例分为AR低表达(>1%且≤10%)、中表达(>10%且≤50%)及高表达(>50%)3组。计数资料的组间比较采用χ2检验,等级资料的组间比较采用秩和检验。采用Logistic回归分析对影响AR表达的各项因素进行多因素分析。

结果

972例乳腺癌患者中,AR阳性率为87.7%(852/972)。AR阳性及AR阴性2组患者在组织学分级、ER表达、PR表达、Ki67表达、HER-2表达、分子分型方面比较,差异具有统计学意义(Z=-6.089,P<0.001;χ2=153.920,P<0.001;χ2=121.064,P<0.001;χ2=4.950,P=0.026;χ2=13.645,P<0.001;Z=-9.799,P<0.001)。多因素分析结果显示组织学分级(2级与3级比较:OR=2.206,95%CI:1.302~3.740,P=0.003)、ER(阳性与阴性比较:OR=19.174,95%CI:6.150~59.777,P<0.001)、PR(阳性与阴性比较:OR=4.723,95%CI:2.070~10.777,P<0.001)、HER-2表达(阳性与阴性比较:OR=3.807,95%CI:1.363~10.638,P=0.011)和分子分型(luminal B型、HER-2阳性型和三阴型分别和luminal A型比较:OR=2.187,95%CI:1.013~4.723,P=0.046;OR=27.951,95%CI:4.051~192.870,P=0.001;OR=7.889,95%CI:1.396~44.569,P=0.019)均是AR阳性表达的独立影响因素。AR阳性的852例患者中,低表达组55例(6.5%,55/852),中表达组158例(18.5%,158/852),高表达组639例(75.0%,639/852)。3组患者的组织学分级、ER表达、PR表达和分子分型比较,差异有统计学意义(H=14.126,P=0.001;χ2=20.211,P<0.001;χ2=21.090,P<0.001;H=13.413,P=0.001)。进一步两两比较结果显示:AR高表达组患者中组织学分级2级比例、ER阳性率、PR阳性率高于AR低表达组和中表达组(P=0.002、0.009;χ2=5.898、17.891,P=0.015、P<0.001;χ2=20.157、6.827,P<0.001、P=0.009),组织学分级3级和三阴型乳腺癌患者比例低于低表达组和中表达组(P=0.003、0.009;P=0.028、0.012)。

结论

乳腺癌患者的AR表达率较高,AR阳性细胞比例越高的患者组织学分级越低、ER及PR表达率越高。

Objective

To explore the expression of androgen receptor (AR) in breast cancer tissue and its influencing factors.

Methods

The clinical data of 972 patients with primary breast cancer admitted to the First Affiliated Hospital of Dalian Medical University from April 2016 to November 2019 were retrospectively analyzed. According to the expression of AR, the patients were divided into AR positive group and AR negative group. The patients in AR positive group were subdivided into three groups according to the proportion of AR positive cells: low expression (>1% and ≤10%), medium expression (>10% and ≤ 50%), and high expression (>50%). χ2 test was used for the comparison of the count data and rank sum test was used for the comparison of the rank data. Multivariate logistic regression analysis was used to analyze the influencing factors of AR expression.

Results

Among 972 patients with breast cancer, the positive rate of AR was 87.7% (852/972). Histological grade, ER expression, PR expression, Ki67 expression, HER-2 expression and molecular subtype all presented a significant difference between AR positive group and AR negative group (Z=-6.089, P<0.001; χ2=153.920, P<0.001; χ2=121.064, P<0.001; χ2=4.950, P=0.026; χ2=13.645, P<0.001; Z=-9.799, P<0.001). The results of multivariate analysis showed that histological grade(grade 2 vs grade 3: OR=2.206, 95%CI: 1.302-3.740, P=0.003), ER expression (positive vs negative: OR=19.174, 95%CI: 6.150-59.777, P<0.001); PR expression (positive vs negative: OR=4.723, 95%CI: 2.070-10.777, P<0.001), HER-2 expression (positive vs negative: OR=3.807, 95%CI: 1.363-10.638, P=0.011), and molecular subtype(luminal B vs luminal A: OR=2.187, 95%CI: 1.013-4.723, P=0.046; HER-2 positive vs luminal A: OR=27.951, 95%CI: 4.051-192.870, P=0.001; triple negative vs luminal A: OR=7.889, 95%CI: 1.396-44.569, P=0.019) were independent influencing factors for AR positive expression. Among 852 AR-positive patients, 55 patients had low expression (6.5%, 55/852), 158 patients had medium expression (18.5%, 158/852), and 639 patients had high expression (75.0%, 639/852). There was a significant difference in histological grade, ER expression, PR expression and molecular subtype among the three groups (H=14.126, P=0.001; χ2=20.211, P<0.001; χ2=21.090, P<0.001; H=13.413, P=0.001). The results of pairwise comparison showed that the proportion of patients with histological grade 2, ER positive rate and PR positive rate in patients with high expression of AR were significantly higher than those in patients with low or medium expression of AR(P=0.002, 0.009; χ2=5.898, 17.891, P=0.015, P<0.001; χ2=20.157, 6.827, P<0.001, P=0.009), respectively, while the proportion of patients with histological grade 3 and triple negative breast cancer was significantly lower(P=0.003, 0.009; P=0.028, 0.012).

Conclusion

The breast cancer patients show high expression of AR. Patients with a higher proportion of AR-positive cells have lower histologic grade and higher ER/PR expression rates.

表1 乳腺癌患者雄激素受体表达情况影响因素的Logistic回归分析变量赋值表
图1 雄激素受体在乳腺癌患者中的表达情况(SP ×100) a图为AR表达阴性;b图为AR低表达;c图为AR中表达;d图为AR高表达
表2 972例乳腺癌患者雄激素受体阳性组和阴性组的临床病理特征比较[例(%)]
临床病理特征 雄激素受体阴性(n=120) 雄激素受体阳性(n=852) 检验值 P
年龄        
  <35岁 7(5.8) 29(3.4) χ2=1.126 0.289
  ≥35岁 113(94.2) 823(96.6)
月经状态        
  绝经前 57(47.5) 336(39.4) χ2=2.840 0.092
  绝经后 63(52.5) 516(60.6)
组织学分级        
  1级 2(1.7) 25(2.9) Z=-6.089 <0.001
  2级 36(30.0) 500(58.7)
  3级 82(68.3) 327(38.4)
肿瘤大小        
  ≤2 cm 66(55.0) 517(60.7) Z=-1.205 0.228
  >2 cm且<5 cm 48(40.0) 301(35.3)
  ≥5 cm 6(5.0) 34(4.0)
淋巴结转移        
  N0 80(66.7) 510(59.9) Z=-1.457 0.145
  N1 28(23.3) 227(26.6)
  N2 7(5.8) 80(9.4)
  N3 5(4.2) 35(4.2)
临床分期        
  Ⅰ期 47(39.2) 368(43.2) Z=-0.440 0.660
  Ⅱ期 58(48.3) 360(42.3)
  Ⅲ期 15(12.5) 124(14.6)
脉管癌栓        
  22(18.3) 153(18.0) χ2=0.010 0.920
  98(81.7) 699(82.0)
神经侵犯        
  8(6.7) 89(10.4) χ2=1.672 0.196
  112(93.3) 763(89.6)
软组织浸润        
  1(0.8) 32(3.8) χ2=1.921 0.166
  119(99.2) 820(96.2)
ER表达        
  阳性 43(35.8) 725(85.1) χ2=153.920 <0.001
  阴性 77(64.2) 127(14.9)
PR表达        
  阳性 40(33.3) 683(80.2) χ2=121.064 <0.001
  阴性 80(66.7) 169(19.8)
HER-2表达        
  阳性 14(11.7) 233(27.3) χ2=13.645 <0.001
  阴性 106(88.3) 619(72.7)
Ki67表达        
  <14% 16(13.3) 189(22.2) χ2=4.950 0.026
  ≥14% 104(86.7) 663(77.8)
分子分型        
  luminal A型 13(10.8) 161(18.9) Z=-9.799 <0.001
  luminal B型 37(30.8) 576(67.6)
  HER-2阳性型 9(7.5) 76(8.9)
  三阴型 61(50.8) 39(4.6)
表3 972例乳腺癌患者雄激素受体阳性表达影响因素的Logistic回归分析
表4 852例雄激素受体阳性乳腺癌患者雄激素受体表达水平与临床病理特征的关系[例(%)]
临床病理特征 低表达组(n=55) 中表达组(n=158) 高表达组(n=639) 检验值 P
年龄          
  <35岁 3(5.5) 6(3.8) 20(3.1) χ2=0.924 0.630
  ≥35岁 52(94.5) 152(96.2) 619(96.9)
月经状态          
  绝经前 23(41.8) 64(40.5) 249(39.0) χ2=0.265 0.876
  绝经后 32(58.2) 94(59.5) 390(61.0)
组织学分级          
  1级 0(0) 5(3.2) 20(3.1) H=14.126 0.001
  2级 25(45.5) 79(50.0) 396(62.0)a、b
  3级 30(54.5) 74(46.8) 223(34.9)a、b
肿瘤大小          
  ≤2 cm 29(52.7) 86(54.4) 402(62.9) χ2=5.846 0.054
  >2 cm且<5 cm 23(41.8) 63(39.9) 215(33.6)
  ≥5 cm 3(5.4) 9(5.7) 22(3.5)
淋巴结转移          
  N0 35(63.6) 91(57.6) 384(60.1) H=0.826 0.662
  N1 13(23.6) 42(26.6) 172(26.9)
  N2 3(5.5) 16(10.1) 61(9.5)
  N3 4(7.3) 9(5.7) 22(3.4)
临床分期          
  Ⅰ期 19(34.5) 61(38.6) 288(45.1) H=3.670 0.160
  Ⅱ期 27(49.1) 71(44.9) 262(41.0)
  Ⅲ期 9(16.4) 26(16.5) 89(13.9)
脉管癌栓          
  10(18.2) 30(19.0) 113(17.7) χ2=0.148 0.929
  45(81.8) 128(81.0) 526(82.3)
神经侵犯          
  6(10.9) 13(8.2) 70(11.0) χ2=1.020 0.600
  49(89.1) 145(91.8) 569(89.0)
软组织浸润          
  1(1.8) 10(6.3) 21(3.3) χ2=3.855 0.146
  54(98.2) 148(93.7) 618(96.7)
ER          
  阳性 37(67.3) 127(80.4) 561(87.8)a、b χ2=20.211 <0.001
  阴性 18(32.7) 31(19.6) 78(12.2)a、b
PR          
  阳性 32(58.2) 121(76.6)a 530(82.9)a χ2=21.090 <0.001
  阴性 23(41.8) 37(23.4)a 109(17.1)a
HER-2          
  阳性 14(25.5) 48(30.4) 171(26.8) χ2=0.941 0.625
  阴性 41(74.5) 110(69.6) 468(73.2)
Ki67          
  <14% 10(18.2) 32(20.3) 147(23.0) χ2=1.101 0.577
  ≥14% 45(81.8) 126(79.7) 492(77.0)
分子分型          
  luminal A型 7(12.7) 24(15.2) 130(20.3) H=13.413 0.001
  luminal B型 34(61.8) 104(65.8) 438(68.5)
  HER-2阳性型 5(9.1) 19(12.0) 52(8.1)
  三阴型 9(16.4) 11(7.0) 19(3.0)a、b
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