雌孕激素受体阴性乳腺癌分子亚型临床及病理特点［摘要］目的分析HER-2阳性型和三阴性两种雌孕激素受体阴性乳腺癌亚型的临床特征和预后状况，探讨多因素对激素受体阴性乳腺癌预后的影响，以及激素受体阴性乳腺癌个体化综合治疗的理论基础。方法收集2005年1月〜2011年7月南京医科大学附属无锡市妇幼保健院收治的81例激素受体阴性乳腺癌的临床病理资料，根据免疫组织化学方法(IHC)检测的人类表皮生长因子受体2(HER-2)状态，分为两组：ER、PR、HER-2三阴性组和HER-2阳性组(IHC3+)。回顾性分析两组患者的临床病理特征和预后情况。结果三阴性乳腺癌51例，HER-2阳性乳腺癌30例。平均发病年龄分别为49.7、52.7岁。三阴性组临床分期为III期及淋巴结转移的患者比例明显低于HER-2阳性组比例(P0.05)；三阴性组的组织学高级别、P53阳性率高于HER-2阳性组，但差异无统计学意义(P>0.05)o两组随访7〜83个月，12例患者发生复发或死亡。单因素分析显示，激素受体阴性乳腺癌患者的无病生存期与淋巴结状态、脉管浸润有关；多因素分析显示，脉管浸润是激素受体阴性乳腺癌患者的独立预后指标。结论激素受体阴性乳腺癌中，三阴性乳腺癌和HER-2阳性乳腺癌有各自的临床病理特点。脉管浸润情况是激素受体阴性乳腺癌复发的独立影响因素。［关键词］乳腺癌；三阴性；人类表皮生长因子受体2；临床病理特征；预后；免疫组织化学［中图分类号］R737.9［文献标识码］C［文章编号］1673-7210(2012)08(b)-0097-04ClinicalandpathologicalcharacteristicsanalysisforhormonereceptornegativebreastcancermolecularsubtypeDINGYunlLUXiaoweilMATaolYINYongxiang2CHENDaozhenlLIUXiao3A1.DepartmentofBreast,WuxiMaternityandChildHea1thHospitalAffiliatedtoNanjingMedicalUniversity,JiangsuProvince,Wuxi214002,China；2.DepartmentofPathology,WuxiMaternityandChildHealthHospitalAffiliatedtoNanjingMedicalUniversity,JiangsuProvince,Wuxi214002,Chirm；3.DepartmentofThyroid,BreastSurgery,WuxiPeoplezsHospitalAffiliatedtoNanjingMedicalUniversity,JiangsuProvince,Wuxi214023,China［Abstroct］ObjectiveToanalyzetheclinicalfeaturesofdifferenthormonereceptornegativebreastcancersubtypesHER-2positiveandtriple-negativesubtype),toinvestigatetheprognosticfactorsofhormonereceptornegativebreastcancer,andtrytofindtheevideneeofcombinedandindividualizedtreatmentforpatientswithhormonereceptornegativebreastcancer・MethodsClinicaldataof81patientswithhormonereceptornegativebreastcancer,treatedinWuximaternityandchildhea1thhospitalaffiliatedNanjingmedicaluniversityfromJanuary2005toJuly2011,werecollectedandanalyzedinthisstudy.AccordingtotheHER-2statusdetectedbyimmunohistochemistry,thepatientsweredividedintotwogroups：thegroupoftriplenegative,thegroupofHER-2positive(IHC3+)・Thedifferenceoftheclinicopathologicalfeaturesandprognosisamongthetwogroupswerecompared.Results51casesweretriple-negativebreastcancers,30caseswereHER-2positivebreastcancers,theaverageageofpatientswiththetwosubtypewas49.7and52.7respectively.ComparedwiththegroupofHER-2positive,thegroupoftriplenegativeanddecreasedsignificantlyintheratiooflymphnodemetastasisandclinicalstageIII(P<0.05).Therewasnosignificantdifferenceinsizeofcancer,vascularinvasion,thepositiverateofVEGFandP53,highlevelofhistolog(P>0.05).Thefollow-updurationrangedfrom7monthsto83months,12casesofthemwerefoundtohavelocaltumorrecurrenceordistantmetastaticdisease・Theunivariateanalysisshowedthatlymphnodemetastasisandvascularinvasionwerecorrelatedwiththedisease-freesurvivalofhormonereceptornegativebreastcancer・However,onlyvascularinvasionwasshowedtobeanindependentprognosticfactorassessedbymultivariateanalysis・ConelusionPatientswithdifferentsubtypeofhormonereceptornegativebreastcancerhavedifferenttheclinicopathologicalfeatures・Thevascularinvasionisanindependentprognosticfactorofthepatientswithhormonereceptornegativebreastcancer.
