文章摘要

乳腺浸润性导管癌分子亚型与腋窝淋巴结转移的关系

作者: 1王红鲜, 1李呈英, 2王开昕, 1齐柯, 1张好云, 1冯铎, 1卫文俊, 1陈天文, 1林秋生
1 广东医科大学附属深圳南山医院甲乳外科 ，广东 深圳 518052
2 广东医科大学附属深圳南山医院病理科，广东 深圳 518052
通讯: 王红鲜 Email: hnsmx001@yeah.net
DOI: 10.3978/.10.3978/j.issn.1005-6947.2016.05.013
基金: 广东省医学科研基金资助项目, A2014664

摘要

目的：探讨乳腺浸润性导管癌不同分子亚型与其腋窝淋巴结转移的关系。方法：根据乳腺癌分子分型标准，将243例原发乳腺浸润性导管癌的手术患者分为Luminal A型、Luminal B型[又分为HER-2（-）和HER-2（+）]、HER-2过表达型和三阴型。结合临床病理资料，分析各分子亚型的分布特点，以及与腋窝淋巴结转移的关系。结果：243例患者中，Luminal B [HER-2（-）]型最多（78例，32.1%），其次是Luminal A型（58例，23.87%），随后为三阴型（41例，16.87%）、HER-2过表达型（34例，13.99%）、Luminal B [HER-2（+）]型（32例，13.17%）；94例（38.68%）发生腋窝淋巴结转移，各分子亚型患者腋窝淋巴结转移发生率差异有统计学意义（P<0.05），其中Luminal B [HER-2（-）]型（42例，53.85%）和Luminal B [HER-2（+）]型（15例，46.88%）中发生率最高，且两者间差异无统计学意义（P>0.05），其后依次为Luminal A型（19例，32.76%），三阴型（12例，29.27%），HER-2过表达型（6例，17.65%）；各分子亚型分布在累及1~3枚及≥４枚淋巴结转移的分组中，差异均无统计学意义（均P>0.05），但前者Luminal B [HER-2（+）]型最多，HER-2过表达型最少，而后者HER-2过表达型最多，Luminal B [HER-2（+）]型最少。结论：乳腺浸润性导管癌的分子分型对评估腋窝淋巴结转移状况、判断疾病状态有一定参考价值，可成为制定个体化诊治策略的依据。
关键词： 乳腺肿瘤 淋巴转移 分子亚型

Relationship between molecular subtypes of breast invasive ductal carcinoma and axillary lymph node metastasis

Authors: 1WANG Hongxian, 1LI Chengying, 2WANG Kaixin, 1QI Ke, 1ZHANG Haoyun, 1FENG Duo, 1WEI Wenjun, 1CHEN Tianwen, 1LIN Qiusheng
1 Department of Thyroid and Breast Surgery, Affiliated Nanshan Hospital, Guangdong Medical University, Shenzhen, Guangdong 518052, China
2 Department of Pathology, Affiliated Nanshan Hospital, Guangdong Medical University, Shenzhen, Guangdong 518052, China

CorrespondingAuthor:WANG Hongxian Email: hnsmx001@yeah.net

Abstract

Objective: To investigate the relationship between different molecular subtypes of breast invasive ductal carcinoma (IDC) and axillary lymph node metastasis. Methods: According to the molecular classification criteria of breast cancer, the 243 patients with primary breast IDC undergoing surgical treatment were divided into luminal A, luminal B [further subdivided into HER-2 (–) and HER-2 (+)], HER-2 over expression and triple-negative type. Combining with the clinical pathological data, the distribution characteristics of various molecular subtypes, and the relations of different molecular subtypes with axillary lymph node metastasis were analyzed. Results: Among the 243 patients, cases with Luminal B [HER-2 (–)] type accounted for the majority (78 cases, 32.1%), and Luminal A type was the next (58 cases, 23.87%), followed by triple-negative (41 cases, 16.87%), HER-2 over expression (34 cases, 13.99%) and Luminal B [HER-2(+)] type (32 cases, 13.17%), successively. Axillary lymph node metastasis occurred in 94 cases (38.68%), and the incidence of axillary lymph node metastasis was statistically different among patients with different molecular subtypes (P<0.05). It was highest in those with luminal B [HER-2 (–)] (42 cases, 53.85%) or Luminal B [HER-2 (+)] type (15 cases, 46.88%), with no statistical difference between them (P>0.05), followed by Luminal A (19 cases, 32.76%), triple-negative (12 cases, 29.27%) and HER-2 over expression type (6 cases, 17.65%), successively; no significant difference was found in distribution of the molecular subtypes either in group of patients with involvement of 1 lymph node to 3 lymph nodes or ≥ 4 lymph nodes (both P>0.05), although the number of cases with Luminal B [HER-2 (+)] type was highest and HER-2 over- expression type was lowest in the former, while the number of cases with HER-2 over- expression type was highest and Luminal B [HER-2(+)] type was lowest in the latter. Conclusion: In breast IDC, molecular subtype has certain reference value for assessing axillary lymph node metastasis and judging disease status, and it can probably be used as a basis for making individualized diagnosis and treatment strategy.
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