目的 研究乳腺癌患者雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER-2）表达情况及免疫组织化学分子亚型分布。 方法 对2003年1月－2008年9月四川大学华西医院病理科3 365例乳腺癌病理报告存档资料进行激素受体（ER/PR）、HER-2表达情况及免疫组织化学分子亚型分布进行分析。 结果 3 365例确诊的乳腺癌患者中，ER阳性1 824例（54.2%），PR阳性1 841例（54.7%），HER-2过表达284例（8.4%）。相关分析显示ER与PR表达呈正相关（P＜0.001），HER-2与ER、PR表达均呈负相关（P＜0.001）。免疫组织化学分子亚型结果显示luminal A型最常见，为1 993例（59.2%）；basal-like型为623例（18.5%）；HER-2过表达型为169例（5.0%）；luminal B型最少，为115例（3.4%）；未分类的为465例（13.8%）。 结论 乳腺癌患者激素受体及HER-2表达有特殊性，激素受体阳性率＞50%，HER-2阳性率在不同研究中显示出不同的结果，尚需进一步研究；ER、PR与HER-2具有良好的相关性；免疫组织化学分子亚型中luminal A型最常见。
【摘要】 目的 探讨乳腺癌不同分子亚型腋窝淋巴结转移的状态及预后分析。 方法 对2005年1月－2007年12月收治的125例乳腺癌患者进行分子分型，对腋窝淋巴结转移状态进行分析并结合随访结果进行预后分析。 结果 Luminal A型63例，16例淋巴结转移，转移率为25.4%；Luminal B型19例，7例淋巴结转移，转移率为36.8%；HER-2过表达型26例，11例淋巴结转移，转移率为42.3%；Basal-like 型17例，9例淋巴结转移，转移率为52.9%。其中Luminal A型淋巴结转移率与Basal-like 型比较差异有统计学意义（Plt;0.05），其余型间比较差异无统计学意义（Pgt;0.05）。运用χ2检验各分子亚型在肿瘤大小的差异无统计学意义（Pgt;0.05）。经过2~5年随访，8例患者出现局部复发或远处转移，其中Luminal B型2例，HER-2过表达型5例，Basal-like 型1例。8例中有3例因肝转移死亡，另5例接受治疗现仍生存。 结论 乳腺癌的分子分型可作为腋窝淋巴结转移的预测指标，HER-2过表达型和Basal-like 型预后较差，将为今后制定乳腺癌个体化治疗提供重要依据。【Abstract】 Objective To analyze the axillary lymph nodes metastasis of various breast cancer molecular subtypes and its prognosis. Methods Molecular subtypes of 125 cases of operable breast cancer diagnosed and treated between January 2005 and December 2007 were categorized, and the axillary lymph nodes metastasis of these types was analyzed. At the same time, we analyzed its prognosis status with the results of the follow-up. Results Among the 125 cases, there were 63 luminal A cases in which 16 (25.4%) were found to be axillary lymph nodes metastasis. Among the 19 luminal B cases, there were 7 (36.8%) axillary lymph nodes metastases. There were 11 cases (42.3%) of axillary lymph nodes metastasis in the 26 cases of HER-2 (+) subtype. In the 17 cases of basal-like subtye, 9 (52.9%) were axillary lymph nodes metastases. As for the axillary lymph nodes metastatic rate, only basal-like subtype was higher than luminal A subtype with a statistically significant difference (Plt;0.05). Differences between all other subtypes were not significant (Pgt;0.05). The molecular subtypes did not differ in tumor size (Pgt;0.05) according to the result of chi-square test. During the 2 to 5-year follow-up, 8 of the 125 patients were found to have local tumor recurrence or distant metastatic disease, which included 2 luminal B cases, 5 HER-2 (+) subtype cases, and 1 basal-like subtype case. In those 8 patients, 3 died of liver metastases and 5 survived and are still accepting treatment now. Conclusions Molecular subtyping can provide important information of axillary lymph nodes metastatic status. HER-2 over-expression and basal-like subtype have a poor prognosis, which is an important basis for individual treatment of breast cancer in the future.
Objective To study the expressions of Delta-like ligand 4 （DLL4） and S100A4 in breast carcinoma of differect molecular subtypes and explore its clinical significance. Methods The expressions of DLL4 and S100A4 in all molecular subtypes were tested by SP immunohistochemistry in 108 cases of breast carcinoma and 40 cases of paracancerous tissues from Taihe Hospital. The Luminal A， Lumianl B， HER-2 over-expression， and basal-like subtypes was 51， 26， 17， and 14 cases， respectively. Then the correlation of DLL4 and S100A4 expression with patients’ clinical and pathological features were analyzed. Results The positive expression rates of DLL4 and S100A4 in breast carcinoma was 67.6%（73/108）and 62.0%（67/108）respectively， which were significantly higher than those in paracancerous tissues〔22.5%（9/40） and 45.0%（18/40）〕， P＜0.05. The positive expression rates of DLL4 and S100A4 in breast carcinoma tissues of HER-2 over-expression and basal-like subtypes were significantly higher than those in breast carcinoma tissues of Luminal A and Luminal B subtypes （P＜0.05）. The expressions of DLL4 and S100A4 in breast carcinoma tissues with lymph node metastasis and without lymph node metastasis were significantly different（P＜0.05）. There was positiver elationship between the expressions of DLL4 and S100A4 in breast carcinoma tissues（rs=0.217，P＜0.01）. Conclusions DLL4 and S100A4 are highly expressed in breast carcinoma tissues of HER-2 over-expression and basal-like subtypes， and are all related with prognosis of breast carcinoma. These results suggest that they might be important factors in breast carcinogenesis and tumor development， metastasis. These proteins are indicators of metastasis and predictors for prognosis of breast carcinoma.
ObjectiveTo detect the expression of cyclin D1 in different kinds of clinical molecular subtypes of breast cancer tissue, and to analyze the relationships of the expression to clinicopathologic characteristics and prognosis. MethodsThe expression of cyclin D1 was detected in 175 cases of different kinds of clinical molecular subtypes of breast cancer by immunohistochemical method.The expression was compared among different kinds of clinical molecular subtypes of breast cancer by chi-square test.The correlations with clinicopathologic characteristics were analyzed by Spearman rank correlation.The impact of different expression of cyclin D1 on the prognosis was analyzed by the Kaplan-Meier survival curve. Results①In the positive expression group of cyclin D1 in the breast cancer, Luminal A type was the highest proportion (P < 0.05);but in the negative expression group of cyclin D1 in the breast cancer, Luminal B type was the highest proportion (P < 0.05).②The expression of cyclin D1 had no correlation with clinical stage, histological grade or PR (P > 0.05), was positively correlated with number of lymph node metastasis (rs=0.197, P < 0.01) or ER (rs=0.139, P < 0.05), was negatively correlated with Her-2(rs=-0.131, P < 0.05).③The positive expression of cyclin D1 was stronger, the tumor free survival time was longer (P < 0.05). ConclusionThis study shows that there is a correlation between the positive expression of cyclin D1 and ER, Her-2, or number of lymph node metastasis, and its positive expression prompts a relatively good prognosis, can be used as the prognosis indicator for breast cancer.
ObjectiveTo summarize the progress of diagnosis and treatment in male breast cancer. MethodsThe literatures about the research progress of diagnosis and treatment in male breast cancer were reviewed. ResultsThe diagnosis of male breast cancer relied mainly on clinical manifestations and imaging manifestations, the main treatment of male breast cancer was modified radical operation, combining with radiotherapy, chemotherapy, endocrine therapy, and targeted therapy. ConclusionsThe treatment of male breast cancer is mainly reference the treatment of female breast cancer, which is lack of a clear standard of treatment. Indepth study on the molecular genetic level will provide more accurate care decisions for the treatment of male breast cancer.
ObjectiveTo investigate the effect of breast conservation therapy (BCT) and mastectomy (Mast) on the prognosis of early luminal breast cancer (ELBC).MethodsBy retrieving the PubMed, Embase, Web of Science, CNKI, Wanfang data, and VIP databases, the meta-analysis was performed on the documents that met the inclusion criteria. The Review Manager 5.3 and Stata 12.0 were used for statistical analysis.ResultsA total of 25 articles were included, involving 13 032 patients with ELBC, of which 8 419 underwent the BCT and 4 613 underwent the Mast. The results of meta-analysis showed that there was no significant difference in the postoperative local regional relapse (LRR) between the BCT and the Mast in the treatment of all patients with ELBC [OR=0.84, 95% CI (0.43, 1.64), P=0.61]. For treating with BCT, the local relapse (LR), distant metastasis rate (DMR), disease-free survival (DFS), and overall survival (OS) in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the DMR and DFS in the patients with luminal A/B ELBC were better than those in the patients with luminal-HER2 ELBC (P<0.05). For treating with Mast, the LRR, LR, DMR, and OS in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the LRR in the patients with luminal A/B ELBC was better than that in the patients with luminal-HER2 ELBC (P<0.05).ConclusionsFor patients with ELBC, similar LRR can be obtained by BCT and Mast treatment. Regardless of the surgical strategy, patients with luminal A ELBC are more likely to obtain relatively ideal clinical prognosis. Luminal-HER2 ELBC has the worst prognosis after BCT treatment.
Objective To explore the relationship between the metastatic sites and prognosis in newly diagnosed stage Ⅳ breast cancer. Methods The data of newly diagnosed female patients with stage Ⅳ invasive breast cancer with complete follow-up data from SEER database from 2010 to 2015 were grouped according to different metastatic sites, and the differences of breast cancer-specific survival (BCSS) in different metastatic sites were analyzed by univariate and multivariate Cox. Kaplan-Meier method was used to draw the survival curve, and log-rank test was used to analyze the prognostic factors of BCSS in newly diagnosed stage ⅳ breast cancer. Results A total of 8 407 patients were included in the final analysis. Among them, 5 619 (66.84%) patients were confirmed with bone metastasis only, 1 483 (17.64%) patients with lung metastasis only, 1 096 (13.04%) patients with liver metastasis only, and 209 (2.49%) patients with brain metastasis only. The median follow-up time was 22 months, with 4 180 (49.72%) breast cancer-related deaths and a median BCSS of 39 months in those patients. The location of metastasis in newly diagnosed stage Ⅳ invasive breast cancer was significantly correlated with BCSS (χ2=151.07, P<0.001). Multivariate Cox model analysis showed that the BCSS was worse in patients with liver metastasis [HR=1.34, 95%CI (1.21, 1.49), P<0.001], lung metastasis [HR=1.09, 95%CI (1.04, 1.14), P<0.001] and brain metastases [HR=1.28, 95%CI (1.20, 1.36), P<0.001] than in patients with bone metastases. Further subgroup analysis showed that the BCSS of breast cancer patients with different molecular subtypes and different metastatic sites were also significantly different (P<0.05). Patients with brain and liver metastases in the HR+/HER2– subtype had worse BCSS than those with bone metastases (P<0.001). Patients with brain metastases in the HR+/HER2+ subtype had worse BCSS than those with bone metastases (P=0.001). In HR–/HER2+ subtype, the BCSS of patients with liver metastasis, lung metastasis and brain metastasis were worse than that of patients with bone metastasis (P<0.05). In HR–/HER2– subtype, the BCSS of patients with brain metastasis and liver metastasis were worse than that of patients with bone metastasis (P<0.05) . Conclusion The prognosis of newly diagnosed stage ⅳ breast cancer patients with different metastatic sites is different, and the prognosis of different molecular subtypes and different metastatic sites is also different.