不同分子分型乳腺癌的临床特征及预后分析.doc

不同分子分型乳腺癌的临床特征及预后分析 陈辉亚，张献全 【摘要】 目的 探讨不同分子分型乳腺癌的临床特点以及预后。方法 收集重庆医科大学附属第二医院2009年1月至2012年4月收治的乳腺癌中有完整临床病例和随访资料的手术女性乳腺癌247例，根据雌激素受体（ER）、孕激素受体（PR）、和人表皮生长因子受体2（HER-2）、ki-67的表达情况将乳腺癌分为Luminal A型、Luminal B型、Her-2过表达型和三阴性型4个类型，分析各临床特征对预后的差异及影响预后的因素。结果 Luminal A型117例（47.4%）、Luminal B型56例（22.7%）、Her-2过表达型15例（6.1%）和三阴性型59例（23.9%），各分子分型在组织分级、肿瘤大小、靶向治疗的差异有统计学意义（P＜0.05）。对各类型转移部位差异进行Fisher 确切概率计算，提示Luminal B型、三阴性型转移率较其他类型高，分别为19.6%、17.0%，其中转移部位以骨转移最为常见，但各类型转移部位的差异无统计学意义（P＞0.05）。采用COX回归分析单因素、多因素分析结果显示肿瘤分期、脉管侵犯是影响乳腺癌患者总生存率和无病生存率的独立预后因素。结论 不同分子分型乳腺癌的临床病理不同，其中luminal B型、三阴性型乳腺癌预后较差，因此，明确以上两类乳腺癌患者的危险因素对积极预防具有重要的意义。 【关键词】 乳腺癌；分子分型；临床特征；预后 Clinical Characteristics and Prognosis analysis of Different Subtypes of Breast Cancer 【Abstract】Objective To investigate the clinical characteristics and prognosis analysis of different breast cancer molecular subtypes．Methods Clinical data of 247 patients with histopathologically confirmed resectable breast cancer,treated in the second affiliated hospital of chongqing medical university from Jan．2009 to Apr．2012,were collected and analyzed in this study. Their molecular subtypes were categorized as luminal A,lumihal B,Her-2 over-expressing and triple negative subtypes based on detection of ER,PR,Her-2 expression,ki-67.The correlation of prognosis of different molecular subtypes was analyzed . Results Among the 247 cases,luminal A,lumihal B,Her-2 over-expressing and triple negative subtypes breast cancer accounted for 117 cases（47.4%）,56 cases（22.7%）,15cases（6.1%）and 59 cases（23.9%）. There were no statistically significant differences among different molecular subtypes. Fisher exact calculation differences of etastatic sites for each type of molecule ,suggesting Luminal B ,triple negative transfer rate than other types , respectively19.6%、17.0%，the most common sites of metastases to bone metastases,but no statistically significant differences（P＞0.05）．univariate and multivariate analyses showed that organization classification and pathological