人表皮生长因子受体-2在雌孕激素双阴性乳腺癌中的表达及作用

张勤; 刘红; 赵晶

doi:10.3969/j.issn.1000-8179.2011.03.005

摘要: 目的：研究三阴性乳腺癌和人表皮生长因子受体-2过表达型乳腺癌的临床病理特征，探讨多因素对雌激素（ER），孕激素（PR）双阴性乳腺癌预后的影响。方法：对本院2004年确诊并行手术治疗的1 250例单侧乳腺癌进行回顾性分析，并通过免疫组化和FISH检测筛选三阴性乳腺癌和HER-2过表达型乳腺癌两种亚型，对两组患者在临床病理特征、复发转移部位、以及生存期进行分析。结果：中位随访60个月（6～73个月），两种亚型在发病年龄、月经状态、组织学分级、肿瘤大小和PCNA表达等方面组间差异均无统计学意义。三阴性乳腺癌患者中乳腺癌家族史患者比例（8.9% vs 4.3%， P=0.010）和P53的阳性表达均较高（64.4% vs 60.7%， P=0.006）；HER-2过表达型乳腺癌更易发生腋窝淋巴结转移，且淋巴结大于4枚以上的比例较高（36.6% vs 29.7%， P=0.004），TNM分期Ⅲ期+Ⅳ期的患者比例比三阴性乳腺癌组高（18.3% vs 29.3%， P=0.014）。两亚型乳腺癌在远处转移率和5年无病生存率相比较差异无统计学意义（P>0.05）。结论：三阴性乳腺癌与HER-2过表达型乳腺癌在肿瘤临床病理特征方面有显著性差异，但短期（5年）无病生存率无显著性差异，因此推测HER-2不是ER，PR双阴性乳腺癌的短期生存的独立预后因素。

Abstract: Expression and Significance of Human Epidermal Growth Factor Receptor 2 in Estrogen andProgesterone Receptor Negative Breast CancerQin ZHANG, Hong LIU, Jing ZHAOCorrespondence to: Hong LIU, E-mail: lh713@163.comSecond Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Breast CancerPrevention and Therapy, Tianjin Medical University, Ministry of Education. Key Laboratory of Cancer Prevention and Therapy, Tianjin300060, ChinaAbstract Objective: To compare the clinicopathologic characteristics and prognosis between triple negative breast cancer andother types of breast cancer that overexpress human epidermal growth factor receptor 2 (HER-2) and to investigate the prognostic fac-tors of estrogen and progesterone receptor (ER, PR) negative breast cancer. Methods: A retrospective study of 1,250 female unilateralbreast cancer patients undergoing surgery in our hospital in 2004 was performed. Patients with triple negative breast cancer and HER-2overexpressing breast cancer were identified using immunohistochemistry and FISH. The clinicopathologic characteristics, recurrenceand survival of the patients were summarized. Results: The median follow-up time was 60 months (range, 6-73 months). No significantdifference was found between the phenotype and age, age at menopause, histological grade, or PCNA expression. Triple negative breastcancer patients had a higher percentage of breast cancer family history ( 8.9 & 4.3, P = 0.010 ) and P53 expression ( 64.4 & 60.7, P =0.006 ). Patients with breast cancer overexpressing HER-2 experienced more lymph node metastasis and were more likely to have me-tastasis in more than 4 lymph nodes (36.6 & 29.7, P = 0.004 ). They also had a higher percentage of stage Ⅲ and Ⅳ disease (18.3&29.3, P = 0.014 ). No significant difference in distant metastasis or 5-year disease-free survival was found between the two subtypes (P > 0.05 ). Conclusion: Patients with triple negative breast cancer exhibit many different clinical and histopathological features consis-tent with their specific biology and pathogenesis, and they have 5-year relapse and survival rates similar to patients with ER- andPR-negative, HER2 overexpressing breast cancer. Thus, it is proposed that HER-2 overexpression is not a prognostic factor for ER- andPR-negative breast cancers.Keywords Breast neoplasm; HER-2; Clinicopathologic features; Prognosis