“三阴”型与非“三阴”型乳腺癌间生物学行为差异性研究
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摘要
目的乳腺癌是妇女最常见的恶性肿瘤之一,同时它亦是一种异质性较高的恶性肿瘤。雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子受体-2(Her-2/C-erbB-2)表达均为阴性的乳腺癌亚型—“三阴”型乳腺癌(TNBC)是近年来提出的一种新的乳腺癌类型。此类型乳腺癌具有更强的侵袭性、更差的预后,由于这三种重要的与乳腺癌发生发展密切相关的受体(ER、PR、C-erbB-2)表达均为阴性,故无法应用传统的内分泌治疗及曲妥珠单抗的分子靶向治疗,目前其全身治疗手段较为局限。因此对“三阴”型乳腺癌相对其他类型乳腺癌的流行病学、临床及病理特征、治疗手段及预后方面差异的研究,具有一定的现实意义,也是目前研究的热点。本研究旨在通过回顾性分析总结“三阴”型乳腺癌与非“三阴”型乳腺癌的流行病学及生物学行为差异的特点,以便为指导临床个体化治疗、判定预后及进一步基因学研究等奠定坚实基础。
方法收集并整理宁夏医科大学附属医院及银川市人民医院2002年1月至2004年12月收治、经病理组织学确诊,且有5年完整随访资料的乳腺癌患者231例。所有患者均为女性,通过免疫组化法检测雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(C-erbB-2)表达均为阴性者(即“三阴”型乳腺癌)40例。将231例患者根据ER、PR、C-erbB-2表达情况分为“三阴”型与非“三阴”型两组,即三种受体表达均为阴性者为“三阴”型组,任一受体表达阳性者为非“三阴”型组。对比分析两组的流行病学、临床病理学特点、复发转移、五年生存等方面差异性。结果采用SPSS11.5进行统计分析。
结果1、“三阴”型乳腺癌占17.3%,与非“三阴”型乳腺癌患者相比,两组在发病年龄、月经状况、民族以及有无肿瘤家族史方面无统计学差异。2、“三阴”型组较非“三阴”型组原发肿瘤大(P<0.05),而原发肿瘤部位、淋巴结转移的数目、临床病理分期、病理类型及病理学分级两组间差异均无统计学意义。3、在相同的综合治疗基础上,“三阴”型组复发转移率高(P<0.05),尤其内脏转移率高于非“三阴”型组(P<0.05);4、“三阴”型组3年、5年生存率明显降低(P<0.05),进一步分析发现II期及淋巴结阳性患者5年生存率也较非“三阴”型组明显降低(均P<0.05)。5、Cox比例风险模型进行预后因素分析,本组患者发病年龄、原发肿块大小、临床分期及是否为“三阴”性表达均为乳腺癌的独立危险因素。
结论1、“三阴”型乳腺癌与非“三阴”型乳腺癌相比,具有局部侵袭性强、复发转移率及内脏转移率高的特点。2、“三阴”型乳腺癌较非“三阴”型乳腺癌预后差、生存率低,可能与其治疗方法局限及对一线CAF/CMF化疗方案原发耐药有关。3、“三阴”型乳腺癌为影响乳腺癌患者预后的独立危险因素。
Objective Breast cancer is one of the most frequent malignant tumor in female, at the same time it also is a kind of heterogeneity of higher malignant tumors. While the new type of breast cancer(TNBC), triple-negative breast cancer, is named in the recent years whose immunohistochemistry is not express estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor eceptor-2(Her-2/C-erbB-2). And this kind of breast cancer have more invasion and worse prognosis. Respecting its feature of not express these three receptors, TNBC can not use the orthodox Endocrine therapy and Herceptin. At present its systemic treatments are limited. Therefore to investigate the contrast of clinical pathology characteristic and prognosis between triple-negative breast cancer and non-triple-negetive breast cancer could have certain practical significance and the present study hotspot. Our study aims at summarize the features which are different between this two groups of breast cancer, in order to guide clinical indiidual therapy, prognosis and further genetic study lay solid foundation, etc.
Methods To collect 231 breast cancer patients between Jan, 2002 to Dec, 2004 in the affiliated hospital of Ningxia medicial university and the people hospital of Yinchuan, which were final diagnosis by pathohistology, and have complete follow-up data of five years. All of the patients are women. In the samples, 40 patients are detected non–express estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor eceptor-2(C-erbB-2) by immunohistochemistry. To separate the 231 patients into two group by immunohistochemistry result, triple-negetive group and non-triple-negetive group. To contrast the biological behaviour between the two group, include clinical pathology characteristics and 5 year survival and so on. The results use statistical analysis software SPSS11.5.
Results 1. The triple-negetive group is accounted to 17.3%. The contrast of age, catamenia, nation and onco- family history between the two group have no statistical significance. 2. For clinical pathology characteristics, the triple-negetive group got larger tumor size than the non-triple-negetive group, and the result has statistical significance (P<0.05). But the contrast of primarily site, lymph nodes number, clinical stage, patho- category and patho-class have no statistical significance. 3. Compare to the the non-triple-negetive group, in the same treatment premise, the triple-negetive group transfer rate of relapse and metastasis(P<0.05), especially the internal transfer rate is higher(P<0.05). 4. The triple-negetive group’s 3 years and 5 years of survival rate lower then the non-triple-negetive group obviously(P<0.05). Further discovery that on equal clinical stage and both in lymph nodes positive patients, the triple-negetive group is worse than the non-triple-negetive group on the 5 years survival status (P<0.05). 5. Use cox ratio analysis model to do prognosis analysis, Patient age group, the primary tumor size, and the clinical stages and whether for " triple-negetive " are independent risk factors for breast cancer.
Conclusions 1. To contrast triple-negetive with non-triple-negetive breast cancer, triple-negetive breast cancer has strong local recurrence and metastasis of invasive and internal transfer rate is high. 2. To contrast triple-negetive with non-triple-negetive breast cancer, triple-negetive breast cancer has poor prognosis, and 5 years of survival rate is low. It may relate with the treatment is limited and the first chemotherapy CAF/CMF drug resistance. 3. The non-express of ER、PR、HER-2 is independent influent factor of prognosis.
方法收集并整理宁夏医科大学附属医院及银川市人民医院2002年1月至2004年12月收治、经病理组织学确诊,且有5年完整随访资料的乳腺癌患者231例。所有患者均为女性,通过免疫组化法检测雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(C-erbB-2)表达均为阴性者(即“三阴”型乳腺癌)40例。将231例患者根据ER、PR、C-erbB-2表达情况分为“三阴”型与非“三阴”型两组,即三种受体表达均为阴性者为“三阴”型组,任一受体表达阳性者为非“三阴”型组。对比分析两组的流行病学、临床病理学特点、复发转移、五年生存等方面差异性。结果采用SPSS11.5进行统计分析。
结果1、“三阴”型乳腺癌占17.3%,与非“三阴”型乳腺癌患者相比,两组在发病年龄、月经状况、民族以及有无肿瘤家族史方面无统计学差异。2、“三阴”型组较非“三阴”型组原发肿瘤大(P<0.05),而原发肿瘤部位、淋巴结转移的数目、临床病理分期、病理类型及病理学分级两组间差异均无统计学意义。3、在相同的综合治疗基础上,“三阴”型组复发转移率高(P<0.05),尤其内脏转移率高于非“三阴”型组(P<0.05);4、“三阴”型组3年、5年生存率明显降低(P<0.05),进一步分析发现II期及淋巴结阳性患者5年生存率也较非“三阴”型组明显降低(均P<0.05)。5、Cox比例风险模型进行预后因素分析,本组患者发病年龄、原发肿块大小、临床分期及是否为“三阴”性表达均为乳腺癌的独立危险因素。
结论1、“三阴”型乳腺癌与非“三阴”型乳腺癌相比,具有局部侵袭性强、复发转移率及内脏转移率高的特点。2、“三阴”型乳腺癌较非“三阴”型乳腺癌预后差、生存率低,可能与其治疗方法局限及对一线CAF/CMF化疗方案原发耐药有关。3、“三阴”型乳腺癌为影响乳腺癌患者预后的独立危险因素。
Objective Breast cancer is one of the most frequent malignant tumor in female, at the same time it also is a kind of heterogeneity of higher malignant tumors. While the new type of breast cancer(TNBC), triple-negative breast cancer, is named in the recent years whose immunohistochemistry is not express estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor eceptor-2(Her-2/C-erbB-2). And this kind of breast cancer have more invasion and worse prognosis. Respecting its feature of not express these three receptors, TNBC can not use the orthodox Endocrine therapy and Herceptin. At present its systemic treatments are limited. Therefore to investigate the contrast of clinical pathology characteristic and prognosis between triple-negative breast cancer and non-triple-negetive breast cancer could have certain practical significance and the present study hotspot. Our study aims at summarize the features which are different between this two groups of breast cancer, in order to guide clinical indiidual therapy, prognosis and further genetic study lay solid foundation, etc.
Methods To collect 231 breast cancer patients between Jan, 2002 to Dec, 2004 in the affiliated hospital of Ningxia medicial university and the people hospital of Yinchuan, which were final diagnosis by pathohistology, and have complete follow-up data of five years. All of the patients are women. In the samples, 40 patients are detected non–express estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor eceptor-2(C-erbB-2) by immunohistochemistry. To separate the 231 patients into two group by immunohistochemistry result, triple-negetive group and non-triple-negetive group. To contrast the biological behaviour between the two group, include clinical pathology characteristics and 5 year survival and so on. The results use statistical analysis software SPSS11.5.
Results 1. The triple-negetive group is accounted to 17.3%. The contrast of age, catamenia, nation and onco- family history between the two group have no statistical significance. 2. For clinical pathology characteristics, the triple-negetive group got larger tumor size than the non-triple-negetive group, and the result has statistical significance (P<0.05). But the contrast of primarily site, lymph nodes number, clinical stage, patho- category and patho-class have no statistical significance. 3. Compare to the the non-triple-negetive group, in the same treatment premise, the triple-negetive group transfer rate of relapse and metastasis(P<0.05), especially the internal transfer rate is higher(P<0.05). 4. The triple-negetive group’s 3 years and 5 years of survival rate lower then the non-triple-negetive group obviously(P<0.05). Further discovery that on equal clinical stage and both in lymph nodes positive patients, the triple-negetive group is worse than the non-triple-negetive group on the 5 years survival status (P<0.05). 5. Use cox ratio analysis model to do prognosis analysis, Patient age group, the primary tumor size, and the clinical stages and whether for " triple-negetive " are independent risk factors for breast cancer.
Conclusions 1. To contrast triple-negetive with non-triple-negetive breast cancer, triple-negetive breast cancer has strong local recurrence and metastasis of invasive and internal transfer rate is high. 2. To contrast triple-negetive with non-triple-negetive breast cancer, triple-negetive breast cancer has poor prognosis, and 5 years of survival rate is low. It may relate with the treatment is limited and the first chemotherapy CAF/CMF drug resistance. 3. The non-express of ER、PR、HER-2 is independent influent factor of prognosis.
引文
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