Wei Ya-Ni, Liu Shan, Zhang Meng-Lan, Ke Xue-Xuan, Chen Min, Wei Bing
Department of Pathology, West China Hospital, Sichuan University Chengdu, Sichuan, China.
Department of Pathology, Affiliated Hospital of Hebei University Baoding, Hebei, China.
Int J Clin Exp Pathol. 2019 May 1;12(5):1666-1677. eCollection 2019.
Pure mucinous breast carcinoma (PMBC) accounts for approximately 2% of all breast carcinoma. Overexpression or amplification of human epidermal growth factor receptor 2 (HER2) is rarely observed in PMBC. We retrieved 119 PMBCs, which included 12 HER2-positive PMBCs and 107 HER2-negative PMBCs, to compare the clinicopathologic features between HER2-positive and HER2-negative neoplasms. The assessed parameters included patient age, menstruation, laterality, tumor size, lymph node status, tumor-node-metastasis (TNM) stage, nuclear grade, receptor status, treatment and prognostic features. HER2-positive PMBCs represented approximately 10.1% of the PMBCs examined. HER2-positive PMBCs showed more frequent lymph node metastasis (P=0.038), a significantly higher clinical TNM stage (P<0.001) and nuclear grade (P<0.001), lower estrogen receptor (ER) and progesterone receptor (PR) expression and higher Ki67 expression than the HER2-negative group (P=0.011, P=0.005, and P=0.001, respectively). HER2-positive PMBCs (untreated with HER2-targeted therapy) had a significantly lower overall survival (OS) rate than HER2-negative PMBCs (P=0.005). Nodal metastasis, higher TNM stage and nuclear grade were identified as factors that result in poorer OS of patients with PMBCs (P<0.001, P=0.016, P<0.001, and P<0.001, respectively). Univariate and multivariate Cox analyses confirmed that HER2 status was an independent prognostic factor for PMBCs (P=0.003 and P=0.012, respectively). HER2-positive PMBC is a rare subtype of breast carcinoma with aggressive biological behavior. It is important to identify tumors with these aggressive clinical behaviors and manage them differently. To the best of our knowledge, this study represents the first systematic investigation of the clinicopathologic features of HER2-positive PMBCs.
纯黏液性乳腺癌（PMBC）约占所有乳腺癌的2%。人表皮生长因子受体2（HER2）的过表达或扩增在PMBC中很少见。我们收集了119例PMBC，其中包括12例HER2阳性PMBC和107例HER2阴性PMBC，以比较HER2阳性和HER2阴性肿瘤之间的临床病理特征。评估参数包括患者年龄、月经情况、肿瘤侧别、肿瘤大小、淋巴结状态、肿瘤-淋巴结-转移（TNM）分期、核分级、受体状态、治疗及预后特征。HER2阳性PMBC约占所检查PMBC的10.1%。与HER2阴性组相比，HER2阳性PMBC显示出更频繁的淋巴结转移（P=0.038）、显著更高的临床TNM分期（P<0.001）和核分级（P<0.001），雌激素受体（ER）和孕激素受体（PR）表达较低，Ki67表达较高（分别为P=0.011、P=0.005和P=0.001）。HER2阳性PMBC（未接受HER2靶向治疗）的总生存率（OS）显著低于HER阴性PMBC（P=0.005）。淋巴结转移、更高的TNM分期和核分级被确定为导致PMBC患者OS较差的因素（分别为P<0.001、P=0.016、P<0.001和P<0.001）。单因素和多因素Cox分析证实，HER2状态是PMBC的独立预后因素（分别为P=0.003和P=0.012）。HER2阳性PMBC是一种具有侵袭性生物学行为的罕见乳腺癌亚型。识别具有这些侵袭性临床行为的肿瘤并进行不同的管理非常重要。据我们所知，本研究是对HER2阳性PMBC临床病理特征的首次系统性研究。
