HER-2在浸润性乳腺癌原发肿物与淋巴结转移灶表达差异对预后的影响

发布时间：2018-06-22 10:42

本文选题：HER-2受体 + 乳腺浸润性导管癌　；参考：《吉林大学》2015年硕士论文

【摘要】：目的研究HER-2受体（人表皮生长因子受体II)在浸润性乳腺癌原发灶与淋巴结转移灶之间表达差异及对预后的影响。方法回顾性分析2009年1月~12月我院收治的90例诊断为浸润性乳腺癌并接受乳腺癌改良根治术的患者，应用免疫组化及FISH检测浸润性乳腺原发病灶及转移淋巴结之间HER-2表达,我院对于HER-2受体检测阳性的患者均建议应用赫赛汀靶向治疗，但是这90例中HER-2受体检测阳性的患者由于经济等因素均未进行靶向治疗，，对患者的预后进行随访。通过统计学方法将肿瘤在原发病灶与转移淋巴结之间HER-2表达差异及预后的相关因素进行分析；并根据HER-2在肿瘤的原发灶与转移淋巴结之间表达的差异，把90例乳腺癌患者分成四组：原发病灶HER-2表达阴性/转移淋巴结HER-2表达阴性组、原发病灶HER-2表达阳性/转移淋巴结HER-2表达阴性组、原发病灶HER-2表达阴性/转移淋巴结HER-2表达阳性组和原发病灶HER-2表达阳性/转移淋巴结HER-2表达阳性组，对四组患者的临床特征和无病生存期进行分析。用Kaplan-Meier法进行生存分析，用Log-rank进行检验,并对影响预后的多种因素用Cox比例风险模型。结果1、通过对90例浸润性乳腺癌患者进行分组分析，其中5例患者HER-2在浸润性乳腺癌的原发病灶与转移淋巴结表达不一致，其中2例患者(2.2%)HER-2在原发病灶表达阳性而在转移淋巴结中表达阴性,3例患者(3.3%)HER-2在肿瘤的原发病灶表达阴性而在转移淋巴结表达阳性。Her-2在肿瘤的原发灶以及转移淋巴结中表达存在的差异（P＞0.05）不具有统计学意义。 2、HER-2在浸润性乳腺癌的原发病灶及其转移淋巴结中的表达差异对患者的5年无病生存期具有影响并有统计学意义（P 0.05）。原发病灶诊断为浸润性乳腺癌HER-2阳性的患者5年无病生存率为79.3%，HER-2阴性的患者5年无病生存率为86.9%，转移淋巴结HER-2阳性的患者5年无病生存率为77.4%，HER-2阴性的患者5年无病生存率为88.3%。 3、HER-2在肿瘤的原发病灶表达阴性在转移淋巴结表达阳性的患者有3例，患者的5年无病生存率为33.3%，原发病灶HER-2表达阳性而在转移淋巴结HER-2表达阴性的有2例患者，患者的5年无病生存率为50%，HER-2在肿瘤的原发病灶及转移淋巴结中表达存在差异的患者具有相对较差的5年无病生存率（5.6%）。结论1、通过对患者的5年无病生存期进行比较，HER-2的表达与患者的临床预后关系密切，并可作为影响乳腺癌患者预后的独立指标。 2、HER-2受体在乳腺癌原发病灶表达及转移淋巴结表达差异不具有统计学意义，考虑样本量不够等情况可能影响结果的准确性。 3、HER-2在肿瘤原发病灶及转移淋巴结中表达的差异，表现出了乳腺癌的异质性，其表达差别与患者5年无病生存期相关，HER-2在原发病灶表达阴性而在转移淋巴结表达阳性的患者具有相对较差的5年无病生存期
[Abstract]:Objective to study the difference of expression of HER-2 receptor (human epidermal growth factor receptor II) between primary tumor and lymph node metastasis of invasive breast cancer and its influence on prognosis. Methods from January to December 2009, 90 patients with invasive breast cancer and underwent modified radical mastectomy were retrospectively analyzed. The expression of HER-2 was detected by immunohistochemistry and fish. HER-2 receptor positive patients in our hospital were recommended to use Herceptin targeted therapy, but these 90 cases of HER-2 receptor positive patients were not targeted therapy because of economic factors, the prognosis of the patients were followed up. The difference of HER-2 expression and prognostic factors between primary tumor and metastatic lymph node were analyzed by statistical method, and according to the difference of HER-2 expression between primary tumor and metastatic lymph node, Ninety patients with breast cancer were divided into four groups: the primary tumor HER-2 expression negative / metastatic lymph node HER-2 expression negative group, primary lesion HER-2 positive expression / metastasis lymph node HER-2 expression negative group. The clinical features and disease-free survival time of the four groups were analyzed. Kaplan-Meier method was used to analyze survival, Log-rank test was used, and Cox proportional risk model was used to analyze the factors affecting prognosis. Results 1. According to the analysis of 90 cases of invasive breast cancer, the expression of HER-2 in the primary tumor of invasive breast cancer was not consistent with that of metastatic lymph node in 5 cases. Two patients (2.2%) showed positive expression of HER-2 in primary tumor and three patients (3.3%) showed negative expression of HER-2 in primary tumor, but positive expression of Her-2 in metastatic lymph node in primary tumor and metastatic lymph node. There was no significant difference in the expression of HER-2 in the primary tumor and metastatic lymph nodes of invasive breast cancer (P > 0.05), and the difference in the expression of HER-2 in the primary tumor and metastatic lymph nodes had a significant effect on the 5-year disease-free survival of the patients (P 0.05). The 5-year disease-free survival rate of HER-2 positive patients was 79.3%. The disease-free survival rate of HER-2 negative patients was 86.9%, and that of patients with HER-2 positive metastatic lymph nodes was 77.4%. The disease-free survival rate of HER-2 negative patients was 77.4%. The survival rate was 88. 3%. 3 cases of HER-2 positive expression in metastatic lymph nodes were found in the primary tumor. The 5-year disease-free survival rate of the patients was 33.3%. There were 2 patients with HER-2 positive expression in primary lesion and negative HER-2 expression in metastatic lymph nodes. The 5-year disease-free survival rate of the patients with HER-2 was lower than that of the patients with different expression of HER-2 in the primary tumor and metastatic lymph nodes (5.6%). Conclusion 1. The expression of HER-2 was closely related to the clinical prognosis by comparing the 5-year disease-free survival of the patients. The difference of HER-2 receptor expression in primary breast cancer and metastatic lymph nodes was not statistically significant. The difference of HER-2 expression in primary tumor and metastatic lymph nodes showed the heterogeneity of breast cancer. The difference between HER-2 expression and 5-year disease-free survival was associated with negative expression of HER-2 in primary lesion and a relatively poor 5-year disease-free survival in patients with positive expression in metastatic lymph nodes.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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