• 湖北省婦幼保健院乳腺外科 （武漢，430070）;

【摘要】　目的　 探討乳腺癌不同分子亞型腋窩淋巴結(jié)轉(zhuǎn)移的狀態(tài)及預(yù)后分析。　方法　 對(duì)2005年1月－2007年12月收治的125例乳腺癌患者進(jìn)行分子分型，對(duì)腋窩淋巴結(jié)轉(zhuǎn)移狀態(tài)進(jìn)行分析并結(jié)合隨訪結(jié)果進(jìn)行預(yù)后分析。　結(jié)果　 Luminal A型63例，16例淋巴結(jié)轉(zhuǎn)移，轉(zhuǎn)移率為25.4%；Luminal B型19例，7例淋巴結(jié)轉(zhuǎn)移，轉(zhuǎn)移率為36.8%；HER-2過表達(dá)型26例，11例淋巴結(jié)轉(zhuǎn)移，轉(zhuǎn)移率為42.3%；Basal-like 型17例，9例淋巴結(jié)轉(zhuǎn)移，轉(zhuǎn)移率為52.9%。其中Luminal A型淋巴結(jié)轉(zhuǎn)移率與Basal-like 型比較差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05），其余型間比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05）。運(yùn)用χ2檢驗(yàn)各分子亞型在腫瘤大小的差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05）。經(jīng)過2~5年隨訪，8例患者出現(xiàn)局部復(fù)發(fā)或遠(yuǎn)處轉(zhuǎn)移，其中Luminal B型2例，HER-2過表達(dá)型5例，Basal-like 型1例。8例中有3例因肝轉(zhuǎn)移死亡，另5例接受治療現(xiàn)仍生存。　結(jié)論　 乳腺癌的分子分型可作為腋窩淋巴結(jié)轉(zhuǎn)移的預(yù)測(cè)指標(biāo)，HER-2過表達(dá)型和Basal-like 型預(yù)后較差，將為今后制定乳腺癌個(gè)體化治療提供重要依據(jù)。
【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 (P lt;0.05). Differences between all other subtypes were not significant (P gt;0.05). The molecular subtypes did not differ in tumor size (P gt;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.

引用本文： 陳波,薛明興,葉春梅,黃自明,王蓉,趙松. 乳腺癌不同分子亞型腋窩淋巴結(jié)轉(zhuǎn)移的狀態(tài)及預(yù)后分析. 華西醫(yī)學(xué), 2011, 26(7): 971-974. doi: 復(fù)制

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7. 　Millikan RC, Newman B, Tse CK, et al. Epidemiology of basal-like breast cancer[J]. Breast Cancer Res Treat, 2008, 109(1): 123-139.
8. 　Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy[J]. Clin Cancer Res, 2005, 11(16): 5678-5685.
9. 　Ihemelandu CU, Naab JT, Mezghebe HM, et al. Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women: age-specific prevalence and survival[J]. J Surg Res, 2007, 143(1): 109-118.〖ZK)〗.
10. 　S?rlie T. Molecular portraits of breast cancer: tumour subtypes as distinct disease entities[J]. Eur J Cancer, 2004, 40(18): 2667-2675.
11. 　Livasy CA, Karaca G, Nanda R, et al. Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma[J]. Mod Pathol, 2006, 19(2): 264-271.
12. 　Kim MJ, Ro JY, Ahn SH, et al. Clinicopathologic significance of the basal-like subtype of breast cancer: a comparison with hormone receptor and Her2/neu-overexpressing phenotypes[J]. Hum Pathol, 2006, 37(9): 1217-1226.
13. 　徐兵河, 張萍. 乳腺癌的分子分型與個(gè)體化治療[J]. 中華腫瘤雜志, 2010, 32(9): 641-644.
14. 　Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse[J]. J Clin Oncol, 2010, 28(10): 1684-1691.
15. 　Wong FY, Chin FK, Lee KA, et al. Hormone receptors and her-2 status as surrogates for breast cancer molecular subtypes prognosticate for disease control in node negative asian patients treated with breast conservation therapy[J]. Ann Acad Med Singapore, 2011, 40(2): 90-97.
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  2. 2. 　Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumors[J]. Nature, 2000, 406(6797): 747-752.
  3. 3. 　Ihemelandu CU, Naab JT, Mezghebe HM, et al. Basal cell-like (triple-negative) breast cancer, a predictor of distant metastasis in African American women[J]. Am J Surg, 2008, 195(2): 153-158.
  4. 4. 　Carey LA, Dees EC, Sawyer L, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes[J]. Clin Cancer Res, 2007, 13(8): 2329-2334.
  5. 5. 　Liu H, Fan Q, Zhang Z, et al. Basal-HER2 phenotype shows poorer survival than basal-like phenotype in hormone receptor-negative invasive breast cancers[J]. Hum Pathol, 2008, 39(2): 167-174.
  6. 6. 　Badve S, Turbin D, Thorat MA, et al. FOXA1 expression in breast cancer-correlation with luminal subtype A and survival[J]. Clin Cancer Res, 2007, 13(15 Pt 1): 4415-4421.
  7. 7. 　Millikan RC, Newman B, Tse CK, et al. Epidemiology of basal-like breast cancer[J]. Breast Cancer Res Treat, 2008, 109(1): 123-139.
  8. 8. 　Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy[J]. Clin Cancer Res, 2005, 11(16): 5678-5685.
  9. 9. 　Ihemelandu CU, Naab JT, Mezghebe HM, et al. Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women: age-specific prevalence and survival[J]. J Surg Res, 2007, 143(1): 109-118.〖ZK)〗.
  10. 10. 　S?rlie T. Molecular portraits of breast cancer: tumour subtypes as distinct disease entities[J]. Eur J Cancer, 2004, 40(18): 2667-2675.
  11. 11. 　Livasy CA, Karaca G, Nanda R, et al. Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma[J]. Mod Pathol, 2006, 19(2): 264-271.
  12. 12. 　Kim MJ, Ro JY, Ahn SH, et al. Clinicopathologic significance of the basal-like subtype of breast cancer: a comparison with hormone receptor and Her2/neu-overexpressing phenotypes[J]. Hum Pathol, 2006, 37(9): 1217-1226.
  13. 13. 　徐兵河, 張萍. 乳腺癌的分子分型與個(gè)體化治療[J]. 中華腫瘤雜志, 2010, 32(9): 641-644.
  14. 14. 　Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse[J]. J Clin Oncol, 2010, 28(10): 1684-1691.
  15. 15. 　Wong FY, Chin FK, Lee KA, et al. Hormone receptors and her-2 status as surrogates for breast cancer molecular subtypes prognosticate for disease control in node negative asian patients treated with breast conservation therapy[J]. Ann Acad Med Singapore, 2011, 40(2): 90-97.