乳腺癌不同分子亚型的临床病理特征及预后分析

发布时间：2018-05-30 00:18

本文选题：浸润性乳腺癌 + 分子分型　；参考：《郑州大学》2017年硕士论文

【摘要】：乳腺癌是女性常见的恶性肿瘤。近年来由于医学科学技术的快速发展以及人们就医意识的提高,乳腺癌的死亡率已有所降低,但是由于人们生活方式理念和生态环境的变化,乳腺癌的发病率也日益显著增加。传统的得以认可的判断乳腺癌生物学行为和预后的指标主要有:肿瘤体积、组织学类型、淋巴结转移情况及TNM分期等。但乳腺癌具有明显的异质性。即使同一组织学类型的乳腺癌在治疗反应及生存期等方面存在明显差异。因此,急需能够反应乳腺癌异质性的生物学标记物,以达到个体化治疗的目的。随着分子遗传学的进展,对乳腺癌认识逐步加深,多基因检测对于更好地理解乳腺癌异质性和复杂的生物学行为具有十分重要的意义,基于此提出了乳腺癌分子分型这一概念,可从更深的层面揭示乳腺癌的生物学特性。不同的亚型具有不同的临床和病理特征、不同的治疗反应模式和不同的预后。基于激素受体和HER-2状态以及增殖标记或组织学分级的临床表征能够相对合理地定义乳腺癌的分子亚型以指导乳腺癌患者的个体化治疗。2000年美国斯坦福大学的两位教授首次提出了分子分型的概念,并将其分为5型,基于免疫组织化学(immunohisto-chemistry,IHC)标记的分类为St Gallen专家共识在2011年推荐的,并于2013年再次确认。2013年第13届乳腺癌St Gallen共识将乳腺癌分为四个亚型,LuminalA型:ER与PR均阳性,HER-2阴性,Ki-67低表达(㩳14%),并且多数专家认为PR㧐20%与LuminalA型密切相关。LuminalB型:(1)HER-2阴性:ER阳性,Ki-67高表达(≥14%)或PR阴性或者㩳20%;(2)HER-2阳性:ER阳性,HER-2阳性,任何Ki-67及任何PR;HER-2过表达型:ER和PR阴性,HER-2阳性。基底细胞型:主要是三阴性乳腺癌(ER、PR及HER-2均为阴性)。其中后面两型与2011年会议共识并无差别。传统的临床病理特征如肿瘤大小、淋巴结转移情况、TNM临床分期等指标在一定程度上也会影响患者疾病的预后。本文旨在探讨乳腺癌各分子亚型的临床病理特征及其与患者生存状况的关系,为河南地区女性乳腺癌患者的个体化治疗提供理论与实践依据。目的本研究通过对乳腺癌的临床病理资料的收集,旨在研究乳腺癌不同分子亚型的临床病理特征及其与患者生存状况的关系,为河南地区女性乳腺癌患者的个体化治疗提供理论依据。方法收集538例首次于2012年1月-2012年12月在郑州大学第一附属医院明确诊断为浸润性乳腺癌的病例,采用回顾性分析的方法,将各个临床病理资料建立数据库,包括肿瘤大小、组织学分级、TNM临床分期、年龄、手术方式和治疗手段等。结果1.538例浸润性乳腺癌中,132例(24.53%)为LuminalA型,211例(39.22%)为LuminalB型,83例(15.43%)为HER-2过表达型,112例(20.82%)为三阴性乳腺癌,Luminal型乳腺癌比例占绝大多数。2.不同分子分型在年龄、绝经状态、种族、家族史、淋巴结状态、临床分期、放疗及手术方式方面,差异无统计学意义(P0.05),而在肿瘤大小、病理类型、组织学分级、化疗及内分泌治疗方面差异有统计学意义(P0.05)。3.本研究末次随访日期为2017年2月17日,538例浸润性乳腺癌病例中,死亡40例,失访91例。四种亚型3年总生存率分别为99.2%、96.2%、90.4%和92.9%。单因素分析结果显示肿瘤大小、临床分期、淋巴结转移情况、手术方式、内分泌治疗及分子分型是影响预后的因素,多因素分析结果显示三阴型亚型、淋巴结转移到一定数目或程度时(即N3)均是影响乳腺癌预后的因素。结论三阴性亚型、淋巴结转移到一定数目(即N3)均是影响乳腺癌预后的因素。
[Abstract]:Breast cancer is a common malignant tumor in women. In recent years, because of the rapid development of medical science and technology and the improvement of people's medical awareness, the mortality of breast cancer has been reduced. However, the incidence of breast cancer has been greatly increased due to the changes in the concept of life style and the ecological environment. The main indicators of cancer biological behavior and prognosis are tumor volume, histological type, lymph node metastasis and TNM staging. But breast cancer has obvious heterogeneity. Even the same histological type of breast cancer has obvious differences in the treatment response and life period. Therefore, it is urgent to respond to the biology of breast cancer heterogeneity. With the development of molecular genetics, the understanding of breast cancer is gradually deepened. Multi gene detection is of great significance to better understand the heterogeneity and complex biological behavior of breast cancer. Based on this, the concept of subclassification of breast cancer is proposed, which can reveal milk from a deeper level. The biological characteristics of adenocarcinoma. Different subtypes have different clinical and pathological features, different therapeutic response patterns and different prognosis. The molecular subtypes of breast cancer can be reasonably defined to guide the individualized treatment of breast cancer patients based on the clinical characterization of hormone receptor and HER-2 status, proliferation markers or histological grading. Two professors at the Stanford University in.2000 first proposed the concept of molecular typing and divided them into 5 types. The classification of Immunohisto-chemistry, IHC markers was recommended by the St Gallen expert consensus in 2011. In 2013, the thirteenth breast cancer St Gallen consensus was reconfirmed in 2013 to divide breast cancer into four Subtype, type LuminalA: ER and PR are positive, HER-2 negative, Ki-67 low expression (? 14%), and most experts believe that PR? 20% is closely related to LuminalA type.LuminalB: (1) HER-2 negative: ER positive, Ki-67 high expression (14%) or PR negative or 20%; (2) positive HER-2 positive. Basal cell type: mainly three negative breast cancers (ER, PR and HER-2 are negative). There is no difference between the latter two and the 2011 consensus. The traditional clinicopathological features such as tumor size, lymph node metastasis, and TNM clinical staging can also affect the prognosis of the patients to a certain extent. This article is aimed at exploring milk. The clinicopathological features of the subtypes of adenocarcinoma and the relationship with the survival status of the patients provide the theoretical and practical basis for the individualized treatment of women with breast cancer in Henan. Objective this study aims to study the clinicopathological features and the clinical pathological features of the breast cancer subtypes by collecting the clinicopathological data of the breast cancer. The relationship between the living conditions of the patients was provided for the individualized treatment of women with breast cancer in Henan. Methods 538 cases of invasive breast cancer, which were first diagnosed in the First Affiliated Hospital of Zhengzhou University in January 2012, in December -2012, were collected, and a retrospective analysis was used to establish a database of various clinicopathological data. In 1.538 cases of invasive breast cancer, 132 cases (24.53%) were type LuminalA, 211 (39.22%) was LuminalB, 83 (15.43%) was HER-2 overexpressed, 112 (20.82%) was three negative breast cancer, and Luminal type breast cancer accounted for the vast majority of.2.. There was no significant difference in age, menopause, race, family history, family history, lymph node status, clinical stage, radiotherapy and surgical methods (P0.05), but the difference in tumor size, pathological type, histological grade, chemotherapy and endocrine therapy was statistically significant (P0.05) the last follow-up date of this study was 17 in February 2017, 17 In 538 cases of invasive breast cancer, 40 cases died and 91 cases were lost. The 3 year total survival rate of four subtypes was 99.2%, 96.2%, 90.4%, and 92.9%. single factor analysis showed that the tumor size, clinical stage, lymph node metastasis, operation mode, endocrine therapy and molecular typing were factors affecting the prognosis, and the results of multivariate analysis showed three. The prognostic factors of breast cancer were negative type, lymph node metastasis to a certain number or degree (N3). Conclusion three negative subtypes and a certain number of lymph nodes (N3) are all factors affecting the prognosis of breast cancer.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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