不同T分期乳腺癌患者分子分型与腋窝淋巴结转移的关系及其临床意义

doi:10.13481/j.1671-587x.20160129

摘要/Abstract

摘要：

目的: 探讨不同肿瘤大小(T)分期乳腺癌患者病理分子分型与腋窝淋巴结转移的关系及其临床意义,指导前哨淋巴结活检术的应用,以避免腋窝淋巴结清扫术带来的术后并发症。方法: 回顾性分析本科收治的临床资料完整、首次治疗为手术治疗、T在0~5 cm的2 100例乳腺癌患者的临床病理特征及免疫组织化学检测结果,分析不同T分期乳腺癌患者分子分型与腋窝淋巴结转移的关系。比较不同分子亚型乳腺癌患者腋窝淋巴结转移率的差异,并对影响腋窝淋巴结转移的相关因素进行多因素Logistic回归分析。结果: 不同T分期(1 cm< T≤ 2 cm,2 cm< T≤ 3 cm,3 cm< T≤ 4 cm)间各分子分型乳腺癌患者腋窝淋巴结转移率比较差异均有统计学意义(P<0.05)。T分期为0 cm≤ T≤ 1 cm、1 cm< T≤ 2 cm、2 cm< T≤ 3 cm和3 cm< T≤ 4 cm时,Luminal B型乳腺癌具有较高的淋巴结转移率,转移率分别为40.00%、29.41%、50.00%和65.22%;T分期为4 cm< T≤ 5 cm时,Her-2型乳腺癌腋窝淋巴结转移率最高,为75.00%。在所有的乳腺癌T分期中,Triple-negative型均具有较低的腋窝淋巴结转移率。Her-2过表达是腋窝淋巴结转移的独立危险因素。结论: 不同分子亚型乳腺癌腋窝淋巴结转移特点不同。Luminal B型和Her-2型乳腺癌患者在前哨淋巴结应用时需要更加谨慎。Her-2过表达是腋窝淋巴结转移的独立危险因素。分子分型是对传统的乳腺癌病理分型及分期的重要补充,可以进一步提示乳腺癌的生物学行为,有助于个体化治疗。

关键词: 乳腺肿瘤, 分子分型, 腋窝淋巴结转移, 肿瘤大小

Abstract:

Objective: To explore the relationship between molecular typing and axillary lymph node metastasis in the breast cancer patients with different tumor size(T)stages and its clinical significance,and to guide the application of sentinel lymph node biopsy to avoid the postoperative complications caused by axillary lymph node dissection. Methods: The clinicopathologic features and immunohistochemistry results of 2 100 breast cancer patients whose clinical data were complete with first treatment of surgical treatment and the T of 0-5 cm were retrospectively analyzed.The relationship between various molecular subtyping of breast cancer and axillary lymph node metastasis was analyzed. The differences of axillary lymph node metastasis rates between various molecular subtypes were compared. The relevant factors of axillary lymph node metastasis were analyzed by multivariate Logistic regression analysis. Results: The axillary lymph node metastasis rates among various molecular subtyes had obvious differences when the T of breast cancer were 1 cm< T≤ 2 cm,2 cm< T≤ 3 cm, and 3 cm< T≤ 4 cm(P<0.05). In 0 cm≤ T≤ 1 cm,1 cm< T≤ 2 cm,2 cm< T≤ 3 cm, and 3 cm< T≤ 4 cm, Luminal B type had the higher lymph node metastasis rate, and the rates were 40.00%, 29.41%, 50.00%, and 65.22%. When the tumor size was 4 cm< T≤ 5 cm, the axillary lymph node metastasis rate of Her-2 type was the highest, about 75%. In all the breast cancer T grouping, Triple-negative type had the lowest axillary lymph node metastasis rate. Her-2 overexpression was the independent risk factor for the metastasis of axillary lymph node. Conclusion: The characteristics of axillary lymph node metastasis are different in the breast cancer patients with various molecular subtypes . In the patients with Luminal B type and Her-2 type the sentinel lymph node needs to be more cautious. Her-2 overexpression is the independent risk factor for the metastasis of axillary lymph node. Molecular typing is an important complement to the traditional breast cancer pathological type and stage and it can further suggest the biological behavior of breast cancer and contribute to the development of individualized treatment.

Key words: brest neoplasms, molecular subtype, lymph node metastasis, tumor size

中图分类号:

R737.9

姜朋丽, 付彤, 武盼盼, 郑超, 韩冰, 范志民. 不同T分期乳腺癌患者分子分型与腋窝淋巴结转移的关系及其临床意义[J]. 吉林大学学报(医学版), 2016, 42(01): 144-148.

JIANG Pengli, FU Tong, WU Panpan, ZHENG Chao, HAN Bing, FAN Zhimin. Relationship between molecular typing and axillary lymph node metastasis in breast cancerpatients with different T stages and itsclinical significance[J]. Journal of Jilin University Medicine Edition, 2016, 42(01): 144-148.

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