ER、PR、Her-2、ki-67在乳腺癌原发灶与同期同侧腋窝淋巴结转移灶中的表达

发布时间：2018-06-09 16:47

本文选题：乳腺癌 + 同期腋窝淋巴结转移　；参考：《浙江大学》2017年硕士论文

【摘要】：背景:乳腺癌病灶中激素受体和HER-2及ki-67等标志物的表达水平是乳腺癌分型及全身治疗方案制定的指导性指标。以往我们认为复发/转移灶与原发肿瘤具有一致的分子分型,然而对转移/复发灶重新进行免疫组化评估发现结果与原发病灶存在一定的差异,对术后出现复发/转移的乳腺癌患者再次进行免疫组化评估是目前较为普遍的做法。而对于同期同侧腋窝淋巴结转移灶是否需要单独进行免疫组化评估目前尚无统一意见。方法:本文收集了 2015年1月1日至2017年2月28日在浙江大学医学院附属第二医院经治的病理学确诊的除同期同侧腋窝淋巴结转移外无他处转移的女性乳腺癌患者的临床病理资料。通过比较乳腺原发肿块及同期同侧腋窝淋巴结转移灶的ER、PR、Her-2及ki-67的表达情况,统计其差异性与一致性。结果采用SPSS Statistics 19.0软件分析,P0.05表示有统计学意义。结果:1.在研究的95例患者中,ER在原发灶及同期同侧腋窝淋巴结转移灶中的表达呈现高度一致性,即所有患者的ER表达在原发和腋窝淋巴结中一致。PR由原发灶阳性转变为淋巴结转移灶阴性率为12.0%,由原发灶阴性转变为阳性率为11.5%,总变化率为12.6%。Her-2结果完备的75例患中,Her-2由原发灶阳性转变为腋窝淋巴结转移灶阴性率为4.0%,由阴性转变为阳性率为4.0%,Her-2总变化率为4.0%。93例ki-67结果完备的患者中,ki-67由原发灶阳性转变为腋窝淋巴结转移灶阴性率为19.7%,由阴性转变为阳性率为15.6%,总变化率为18.3%。上述表达变化无统计学差异(P0.05)。2.按年龄、肿瘤大小、腋窝淋巴结转移个数分组分别将ER、PR、Her-2、ki-67进行不一致率分析,均无统计学差异(P0.05)。结论:1.ER、PR、Her-2、ki-67在乳腺癌原发灶与同期同侧腋窝淋巴结转移灶中的表达一致性较好,但均在不同程度上存在一定差异性,但差异无统计学意义且年龄、肿瘤大小、腋窝淋巴结转移个数对这些指标的变化无影响。2.PR、Her-2、ki-67均有从阳性转为阴性、阴性转为阳性的可能,而这些指标存在变化的情况对于治疗方案的制定可能更有意义,在临床过程中,仍建议行全面的病理检查,可能对于部分患者增加了治疗获益的可能性,对于标志物表达的变化的预测治疗疗效的作用仍需长期随访证实,期待大样本随访结果。
[Abstract]:Background: the expression level of hormone receptor, HER-2 and ki-67 in breast cancer focus is the guiding index of breast cancer classification and systemic therapy. In the past, we thought that the recurrence / metastasis had the same molecular classification with the primary tumor. However, the immunohistochemical evaluation of the metastasis / recurrence was different from the primary tumor. It is a common practice to reevaluate the recurrence / metastasis of breast cancer by immunohistochemistry. However, there is no uniform opinion as to whether the ipsilateral axillary lymph node metastases need to be assessed by immunohistochemistry alone. Methods: from January 1, 2015 to February 28, 2017, a pathologically diagnosed female breast cancer patient with no metastasis other than ipsilateral axillary lymph node metastasis was collected from the second affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, from January 1, 2015 to February 28, 2017. The clinicopathological data of the patients were analyzed. By comparing the expression of ERP PRN Her-2 and ki-67 in primary breast masses and axillary lymph node metastases at the same time, the difference and consistency were analyzed. Results SPSS Statistics 19.0 software was used to analyze the statistical significance. The result is 1: 1. The expression of ER in primary and ipsilateral axillary lymph node metastasis was highly consistent in 95 patients. That is, ER expression in all patients was consistent in primary and axillary lymph nodes. PR was changed from primary tumor positive to lymph node metastasis negative rate 12.0, from primary tumor negative to positive rate 11.5. The total change rate was 12.6.Her-2 complete 75 cases. The positive rate of Her-2 from primary tumor to axillary lymph node metastasis was 4.0, and the total change rate of Her-2 from negative to positive was 4.00.93 patients with complete ki-67 results changed from positive primary focus to negative metastasis of axillary lymph node. The sex rate was 19.7g, the change rate from negative to positive was 15.6g, the total change rate was 18.3%. There was no statistical difference in the expression of P0.05. 2. According to age, tumor size and number of axillary lymph node metastasis, the inconsistency rate of ERV PRP Her-2OKi-67 was analyzed, and there was no statistical difference (P 0.05). Conclusion: 1. The expression of Her-2ki-67 in primary breast cancer is consistent with that in axillary lymph node metastasis in the same period, but there are some differences to some extent, but there is no significant difference in age, tumor size, and age, but there is no significant difference in the expression of Her-2ki-67 in primary and ipsilateral axillary lymph node metastases of breast cancer. The number of axillary lymph node metastasis had no effect on the changes of these indexes. 2. The number of axillary lymph node metastasis had no effect on the changes of these indexes. 2. All of the changes in the number of axillary lymph node metastasis had the possibility of changing from positive to negative and negative to positive. However, the changes of these indexes might be more significant for the formulation of treatment plan. It is suggested that comprehensive pathological examination may increase the possibility of therapeutic benefit for some patients, and the effect of predicting therapeutic effect on the change of marker expression still needs to be confirmed by long-term follow-up, and a large sample of follow-up results are expected.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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