[雌激素受体、孕激素受体及人表皮生长因子受体-2在接受乳房切除术的淋巴结阳性乳腺癌患者中的预后价值]

[Prognostic value of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 in node positive breast cancer patients treated by mastectomy].

作者信息

Wang Shu-lian, Li Ye-xiong, Song Yong-wen, Wang Wei-hu, Jin Jing, Liu Yue-ping, Liu Xin-fan, Yu Zi-hao

机构信息

Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2010 Jul;32(7):520-5.

PMID:21029696

Abstract

OBJECTIVE

To evaluate the prognostic value of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (Her-2) in node-positive breast cancer patients treated by mastectomy.

METHODS

The clinicopathological data of 835 breast cancer patients treated by mastectomy from January 2000 to December 2004 were retrospectively analyzed. All had positive axillary nodes without distant metastases and with the immunohistochemistry staining of ER, PR and Her-2 available. 764 (91.5%) patients received anthracycline- and/or taxanes-based chemotherapy. 464 (55.6%) patients received hormonal therapy. Eight (1%) patients received trastuzumab. Postmastectomy radiotherapy were given to 352 out of 437(80.5%)patients with T3-T4 and/or N2-N3 disease and 68 out of 398(20.9%)patients with T1-2N1 disease. Patients were classified into 4 subgroups according to the status of hormone receptors (ER and PR, Rec) and Her-2: Rec(-)/Her-2(-) (triple negative), Rec(-)/Her-2(+), Rec(+)/Her-2(+) and Rec(+)/Her-2(-). End points were isolated locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS) and overall survival (OS).

RESULTS

141 (16.9%) patients were Rec(-)/Her-2(-), 99 (11.9%) Rec(-)/Her-2(+), 157 (18.8%) Rec(+)/Her-2(+) and 438 (52.5%) Rec(+)/Her-2(-). Patients with Rec(+)/Her-2(-) breast cancer had a significantly lower 5-year LRR rate than others (6.2% vs. 12.9%, P = 0.004). Compared with patients with Rec(+) breast cancer, patients with Rec(-) breast cancer had significantly higher 5-year DM rate (26.4% vs. 19.7%, P = 0.0008), lower DFS rate (66.7% vs. 75.6%, P = 0.0001) and lower OS rate (71.4% vs. 84.2%, P = 0.0000). In multivariate analysis, Rec(+)/Her-2(-) was significantly associated with lower risk of LRR. Rec(-) was an independent prognostic factor for higher risk of DM, decreased DFS and OS.

CONCLUSION

ER, PR and Her-2 are independent prognostic factors for locoregional recurrence and survival in node-positive breast cancer patients treated by mastectomy.

摘要

目的

评估雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（Her-2）在接受乳房切除术的淋巴结阳性乳腺癌患者中的预后价值。

方法

回顾性分析2000年1月至2004年12月接受乳房切除术的835例乳腺癌患者的临床病理资料。所有患者腋窝淋巴结均为阳性，无远处转移，且有ER、PR和Her-2的免疫组化染色结果。764例（91.5%）患者接受了以蒽环类和/或紫杉类为基础的化疗。464例（55.6%）患者接受了激素治疗。8例（1%）患者接受了曲妥珠单抗治疗。437例T3-T4和/或N2-N3期患者中的352例（80.5%）以及398例T1-2N1期患者中的68例（20.9%）接受了乳房切除术后放疗。根据激素受体（ER和PR，Rec）和Her-2的状态将患者分为4个亚组：Rec(-)/Her-2(-)（三阴性）、Rec(-)/Her-2(+)、Rec(+)/Her-2(+)和Rec(+)/Her-2(-)。观察终点为孤立性局部区域复发（LRR）、远处转移（DM）、无病生存期（DFS）和总生存期（OS）。

结果

141例（16.9%）患者为Rec(-)/Her-2(-)，99例（11.9%）为Rec(-)/Her-2(+)，157例（18.8%）为Rec(+)/Her-2(+)，438例（52.5%）为Rec(+)/Her-2(-)。Rec(+)/Her-2(-)乳腺癌患者的5年LRR率显著低于其他患者（6.2%对12.9%，P = 0.004）。与Rec(+)乳腺癌患者相比，Rec(-)乳腺癌患者的5年DM率显著更高（26.4%对19.7%，P = 0.0008），DFS率更低（66.7%对75.6%，P = 0.0001），OS率更低（71.4%对84.2%，P = 0.0000）。多因素分析显示，Rec(+)/Her-2(-)与较低的LRR风险显著相关。Rec(-)是DM风险增加、DFS和OS降低的独立预后因素。