摘要
目的:分析不同分子分型的乳腺癌与前哨淋巴结转移的关系。方法:收集2012年10月-2015年4月本院确诊的200例乳腺癌患者资料,对患者进行雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人体表皮生长因子(human epidermal growth factor receptor-2,HER2)及抗原Ki-67的检测,根据上述蛋白的阳性状态对患者进行免疫组化分型,分为luminal A型、luminal B型、三阴型、HER2过表达型。在手术时对患者进行前哨淋巴结活检术(sentinel lymph node biopsy,SLNB),运用单因素和logistic多因素分析影响前哨淋巴结转移的因素。结果:200例患者中,检出SLN转移阴性159例(79.50%),阳性41例(20.50%)。SLN转移阳性患者在年龄≤50岁、TNM分期为T2、组织学分级为Ⅱ级、分子分型为三阴型和HER2过表达型占比均高于SLN转移阴性(P<0.05)。logistic回归分析得出,年龄是SLN转移阳性的保护因素,分子分型是SLN转移阳性的危险因素(P<0.05)。SLN阳性转移数量为1个24例,≥2个17例,不同分子分型患者前哨淋巴结阳性数量比较,差异有统计学意义(P<0.05)。所有患者均获得随访,随访率为100%(200/200),随访时间为60~90个月,随访中位数62个月。200例患者中46例(23.00%)复发,其中luminal A型12例(13.79%)、luminal B型9例(16.98%)、三阴型12例(44.44%)、HER2过表达型13例(39.39%);20例死亡,死亡率为10.00%(20/200),其中luminal A型3例(3.45%)、luminal B型3例(5.66%)、三阴型5例(18.52%)、HER2过表达型9例(27.27%);无病生存134例(67.00%),其中luminal A型72例(82.76%)、luminal B型41例(77.36%)、三阴型10例(37.04%)、HER2过表达型11例(33.33%)。不同分子分型患者的预后比较,差异有统计学意义(χ^2=43.105,P=0.000),与luminal A型和luminal B型比,三阴型和HER2过表达型的无病生存率较低(P=0.000)。结论:影响乳腺癌患者前哨淋巴结转移的因素包括年龄和分子类型,三阴型和HER2过表达型患者预后不佳。
Objective:To analyze the relationship between different molecular types of breast cancer and sentinel lymph node metastasis.Method:From October 2012 to April 2015,200 breast cancer patients diagnosed in our hospital were collected,and the estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor-2 (HER2) and antigen Ki-67 in breast tissue were detected.All patients were divided into luminal A type,luminal B type,triple negative type and HER2 overexpression groups.Sentinel lymph node biopsy (SLNB) was performed on the patients during the operation.The factors affecting the sentinel lymph node (SLN) metastasis were analyzed using single factor and multivariate logistic.Result:Among 200 patients,159 (79.50%) were SLN negative metastasis and 41 (20.50%) were SLN positive metastasis.The proporition of age ≤50 years old,TNM stage of T2,histological grade of Ⅱ,triple negative type and HER2 overexpression type in the SLN positive metastasis were higher than those of the SLN negative metastasis (P<0.05).Logistic regression analysis showed that age was a protective factor for SLN positive metastasis,and molecular typing was a risk factor for SLN positive metastasis (P<0.05).The number of SLN positive metastasis was 1 in 24 cases and ≥2 in 17 cases,there was a statistically significant difference in the number of SLN in patients with different molecular types (P<0.05).All patients were followed up,the follow-up rate was 100% (200/200),the follow-up time was 60-90 months,and the median follow-up was 62 months.Of the 200 patients,46 cases (23.00%) relapsed,including 12 cases (13.79%) luminal A,9 cases (16.98%) luminal B,12 cases (44.44%) triple-negative and 13 cases (39.39%) HER2 overexpression.20 cases (10.00%) died,including 3 cases (3.45%) luminal A,3 cases (5.66%) luminal B,5 cases (18.52%) triple-negative and 9 cases (27.27%) HER2 overexpression type.134 cases (67.00%) were disease-free survival,including 72 cases (82.76%) luminal type A,41 cases (77.36%) luminal type B,10 cases (37.04%) triple negative type and 11 cases (33.33%) HER2 overexpression type,the prognosis of patients with different molecular types was statistically significant (χ^2=43.105,P=0.000),compared with the luminal A and luminal B,the lower disease-free survival rate in the triple negative and HER2 overexpression type (P=0.000).Conclusion:The factors affecting the SLN positive metastasis in breast cancer patients include age and molecular type,and the prognosis of patients with triple negative and HER2 overexpression is poor.
作者
黄恒
崔彬
揭超
刘付霖
米明
张柳江
黄志明
陈燕华
HUANG Heng;CUI Bin;JIE Chao;LIU Fulin;MI Ming;ZHANG Liujiang;HUANG Zhiming;CHEN Yanhua(Lianjiang People’s Hospital,Lianjiang 524400,China;不详)
出处
《中国医学创新》
CAS
2020年第32期5-9,共5页
Medical Innovation of China
基金
湛江市科技计划项目(2018B01034)。
