同期腋窝转移淋巴结受体检测在激素受体阴性乳腺癌中的临床意义

金梁斌; 姚自翔; 孔令泉; 厉红元; 吴凯南

doi:10.3969/j.issn.1000-8179.2013.15.008

同期腋窝转移淋巴结受体检测在激素受体阴性乳腺癌中的临床意义

Clinical significance of hormone receptor status detection in simultaneous axillary metastasis for hormone receptor-negative primary breast cancer patients

摘要

摘要:
目的探讨同期腋淋巴结转移病灶雌激素受体（estrogen receptor，ER）和孕激素受体（progesterone receptor，PR）补测在激素受体阴性浸润性乳腺癌中的临床意义。
方法观察2012年7月至2013年1月，重庆医科大学附属第一医院内分泌乳腺外科门诊随访及住院患者中补测激素受体阴性乳腺癌同期腋淋巴结转移病灶ER和PR的表达情况，所有标本（包括原发癌病灶及同期腋淋巴结转移病灶）的免疫组织化学检测均由重庆医科大学病理检测中心进行，根据检测报告，原发病灶阴性而腋淋巴结转移病灶ER和/或PR阳性者补加内分泌治疗。
结果 56例激素受体阴性乳腺癌中，同期腋淋巴结转移病灶ER阳性8例（14.3%），PR阳性2例（3.6 %），ER和PR均阳性3例（5.4%），共13例（23.3%）因补查腋淋巴结转移病灶ER和/或PR变阳性而在随访中加用内分泌治疗。肿瘤原发病灶与腋转移淋巴结ER和PR均阴性43例（76.7%），即肿瘤原发癌病灶与腋转移淋巴结ER和PR均为阴性表达的总符合率为76.7%，不一致率为23.3%。
结论受体阴性浸润性乳腺癌原发病灶与腋淋巴结转移病灶ER和PR表达具有一定的不一致性，对原发癌病灶激素受体阴性乳腺癌患者应检查其同期腋淋巴结转移病灶受体的表达，可能筛查出原发病灶受体阴性而复发转移病灶受体阳性患者，及时加用内分泌治疗，提高该类患者的疗效，亦可解释部分激素受体阴性而内分泌治疗也有一定疗效的原因。

Abstract:
Objective This study aimed to investigate the clinical significance of hormone receptor status detection in simultaneous axillary metastasis for hormone receptor-negative primary breast cancer patients.
Methods Using immunohistochemical methods, hormone receptor status detection in axillary lymph node metastasis was performed among breast cancer patients with simultaneous axillary metastasis in the First Affiliated Hospital of Chongqing Medical University. The subjects comprised patients who visited the clinic for follow up or those who were hospitalized from July 2012 to January 2013. Endocrine therapy was given for patients diagnosed with positive hormone receptor in their simultaneous axillary metastasis.
Results Out of 56 patients with hormone receptor-negative primary breast cancer, 14.3% gained estrogen receptor (ER), 3.6% gained progesterone receptor (PR), and 5.4% gained ER and PR in their simultaneous axillary metastasis, and then underwent endocrine therapy. The discordance rate of hormone receptor expression between primary tumor and axillary metastasis was 23.3%.
Conclusion Some discordance rates of hormone receptor status between primary tumor and simultaneous axillary metastasis were observed. Through hormone receptor status detection in simultaneous axillary metastasis, we may possibly distinguish patients with negative ER and PR, among whom endocrine therapy may be active.

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