广西家族性乳腺癌临床病理特征的相关研究
发布时间：2018-07-14 16:03
【摘要】：目的：通过回顾性分析家族性乳腺癌和散发性乳腺癌的女性患者的临床病理相关指标,旨在探究家族性乳腺癌和散发性乳腺癌患者的临床病理特征,揭示家族性乳腺癌独特的临床病理学及分子生物学特性,为今后指导女性乳腺癌患者的临床个体化治疗提供理论依据,为进一步研究家族性乳腺癌的遗传易感因素提供参考。方法：收集2013年6月至2015年3月期间在广西医科大学第一附属医院胃肠腺体外科住院并行手术治疗且术后病理证实为乳腺癌的患者722例。通过电话调查、患者返院复查、翻阅病历记录或档案的方式进行随访。按照家族中一级、二级亲属中有1例或以上为乳腺癌患者,将其划为家族性乳腺癌,反之为散发性乳腺癌。根据所制定的病例纳入标准及剔除标准,最后筛选出符合要求的乳腺癌家族史阳性患者43例,无乳腺癌家族史的患者402例。将两组患者的临床病理指标、复发、转移等情况采用x2检验行单因素分析,从临床病理特征、分子生物学行为等方面对家族性乳腺癌与非家族性乳腺癌患者进行分析比较。结果：家族性乳腺癌患者占同期乳腺癌患者的5.9%。家族性乳腺癌患者在组织学分级III级所占的比例(37.2%)明显高过散发性乳腺癌的患者(22.6%),且两组间有统计学差异(x2=4.517,P=0.034)；家族性乳腺癌患者的ER表达阴性率(39.5%)高于散发性乳腺癌患者(25.4%),两组间差异有统计学意义(x2=3.977,P=0.046)；但两组患者在年龄分布(x2=0.149,P=0.928)、民族(χ2=0.167,P=0.683).BMI (χ2=3.075, P=0.380)、绝经状态(x2=0.722,P=0.396)、肿瘤大小(x2=3.864,P=0.145)、病理类型(x2=2.917,P=0.176)、临床分期(x2=1.267,P=0.531)、腋窝淋巴结转移率(x2=0.734,P=0.392)等方面均无统计学意义；在PR(χ2=0.142,P=0.706)、 HER-2(χ2=2.053,P=0.358)、Ki-67 (χ2=0.070,P=0.791)表达上及乳腺癌分子分型(x2=1.129,P=0.770)方面差异也无统计学意义；而有家族史的乳腺癌患者在术后试探性的短期随访时间内发生复发、转移、死亡的总比例(14.0%)高于无家族史的乳腺癌患者(4.5%),两组间差异有统计学意义(x2=5.105,P=0.024)。结论：1、广西地区家族性乳腺癌的发生率低于国外和国内某些地区,与散发性乳腺癌比较在一些临床病理特征上有差异,具体还需结合基因等相关因素进一步探究。2、本地区家族性乳腺癌患者的组织学分级III级所占的比例高,且有统计学差异,提示家族史因素可能与肿瘤的组织分化差、恶性程度高、预后不良相关,有待深入研究。3、本地区家族性乳腺癌ER阴性表达率高于散发性乳腺癌,预示家族性乳腺癌分子生物学行为差,对内分泌治疗不敏感,需采取更为积极的系统性治疗。4、家族性乳腺癌可能预后更差,这还需我们今后继续寻找有价值的临床病理指标,针对指标对不同患者进行个体化治疗。
[Abstract]:Objective: to investigate the clinicopathological features of familial breast cancer and sporadic breast cancer by retrospectively analyzing the clinicopathological features of familial breast cancer and sporadic breast cancer. To reveal the unique clinicopathological and molecular biological characteristics of familial breast cancer, to provide theoretical basis for guiding clinical individualized treatment of female breast cancer patients in the future, and to provide a reference for further study of genetic susceptibility factors of familial breast cancer. Methods: from June 2013 to March 2015, 722 patients with breast cancer were admitted to the first affiliated Hospital of Guangxi Medical University for surgical treatment and proved to be breast cancer by pathology. The patients were followed up by telephone survey, re-examination and review of medical records or files. According to the first degree in the family, one or more of the second-degree relatives were classified as familial breast cancer and sporadic breast cancer. According to the criteria of inclusion and exclusion of breast cancer, 43 patients with positive family history of breast cancer and 402 patients with no family history of breast cancer were selected. The clinicopathological parameters, recurrence and metastasis of the two groups were analyzed and compared between familial breast cancer and non-familial breast cancer in terms of clinicopathological characteristics and molecular biological behavior by using x2 test. Results: familial breast cancer patients accounted for 5.9% of breast cancer patients in the same period. The proportion of familial breast cancer patients in histological grade III (37.2%) was significantly higher than that in sporadic breast cancer patients (22.6%). The negative rate of ER expression in familial breast cancer patients (39.5%) was significantly higher than that in sporadic breast cancer patients (25.4%). However, there was no significant difference in age distribution (x20.149P0. 928), nationality (蠂 20.167 P0. 683), BMI (蠂 2 + 3. 075, P = 0. 380), menopausal status (x 2 + 0. 722), tumor size (x 23. 864P0. 145), pathological type (x 2 = 2. 917), clinical stage (x 2 + 1. 267 P 0. 531), axillary lymph node metastasis rate (x 20.734 P 0. 392) between the two groups. There was no significant difference in the expression of PR (蠂 ~ 2 + 0.142), HER-2 (蠂 ~ (2 +) 2.053) ~ (0.358) and Ki-67 (蠂 ~ (2 +) ~ (0.070) P _ (0.791) and the molecular classification of breast cancer (x _ (2) 1.129) (P _ (0.770), but there was no significant difference in the expression of Ki-67 and the molecular type of breast cancer (x _ (2) 1.129) (P _ (0.770), while the recurrence and metastasis of breast cancer patients with a family history were observed during the tentative follow-up period after operation. The total mortality rate (14.0%) was higher than that in breast cancer patients without family history (4.5%), and the difference between the two groups was statistically significant (x2 + 5.105%, P < 0.024). Conclusion the incidence of familial breast cancer in Guangxi is lower than that in some foreign and domestic areas, and there are differences in some clinicopathological features between Guangxi and sporadic breast cancer. The proportion of histological grade III in familial breast cancer patients in this area is high, and there is statistical difference, which suggests that family history factors may be poor in differentiation with tumor tissue. The negative expression rate of ER in familial breast cancer is higher than that in sporadic breast cancer, which indicates that the molecular biological behavior of familial breast cancer is poor, and it is insensitive to endocrine therapy. It is necessary to take more active systemic therapy. 4. The prognosis of familial breast cancer may be worse. It is also necessary for us to continue to search for valuable clinicopathological indicators and individualized treatment for different patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9
[Abstract]:Objective: to investigate the clinicopathological features of familial breast cancer and sporadic breast cancer by retrospectively analyzing the clinicopathological features of familial breast cancer and sporadic breast cancer. To reveal the unique clinicopathological and molecular biological characteristics of familial breast cancer, to provide theoretical basis for guiding clinical individualized treatment of female breast cancer patients in the future, and to provide a reference for further study of genetic susceptibility factors of familial breast cancer. Methods: from June 2013 to March 2015, 722 patients with breast cancer were admitted to the first affiliated Hospital of Guangxi Medical University for surgical treatment and proved to be breast cancer by pathology. The patients were followed up by telephone survey, re-examination and review of medical records or files. According to the first degree in the family, one or more of the second-degree relatives were classified as familial breast cancer and sporadic breast cancer. According to the criteria of inclusion and exclusion of breast cancer, 43 patients with positive family history of breast cancer and 402 patients with no family history of breast cancer were selected. The clinicopathological parameters, recurrence and metastasis of the two groups were analyzed and compared between familial breast cancer and non-familial breast cancer in terms of clinicopathological characteristics and molecular biological behavior by using x2 test. Results: familial breast cancer patients accounted for 5.9% of breast cancer patients in the same period. The proportion of familial breast cancer patients in histological grade III (37.2%) was significantly higher than that in sporadic breast cancer patients (22.6%). The negative rate of ER expression in familial breast cancer patients (39.5%) was significantly higher than that in sporadic breast cancer patients (25.4%). However, there was no significant difference in age distribution (x20.149P0. 928), nationality (蠂 20.167 P0. 683), BMI (蠂 2 + 3. 075, P = 0. 380), menopausal status (x 2 + 0. 722), tumor size (x 23. 864P0. 145), pathological type (x 2 = 2. 917), clinical stage (x 2 + 1. 267 P 0. 531), axillary lymph node metastasis rate (x 20.734 P 0. 392) between the two groups. There was no significant difference in the expression of PR (蠂 ~ 2 + 0.142), HER-2 (蠂 ~ (2 +) 2.053) ~ (0.358) and Ki-67 (蠂 ~ (2 +) ~ (0.070) P _ (0.791) and the molecular classification of breast cancer (x _ (2) 1.129) (P _ (0.770), but there was no significant difference in the expression of Ki-67 and the molecular type of breast cancer (x _ (2) 1.129) (P _ (0.770), while the recurrence and metastasis of breast cancer patients with a family history were observed during the tentative follow-up period after operation. The total mortality rate (14.0%) was higher than that in breast cancer patients without family history (4.5%), and the difference between the two groups was statistically significant (x2 + 5.105%, P < 0.024). Conclusion the incidence of familial breast cancer in Guangxi is lower than that in some foreign and domestic areas, and there are differences in some clinicopathological features between Guangxi and sporadic breast cancer. The proportion of histological grade III in familial breast cancer patients in this area is high, and there is statistical difference, which suggests that family history factors may be poor in differentiation with tumor tissue. The negative expression rate of ER in familial breast cancer is higher than that in sporadic breast cancer, which indicates that the molecular biological behavior of familial breast cancer is poor, and it is insensitive to endocrine therapy. It is necessary to take more active systemic therapy. 4. The prognosis of familial breast cancer may be worse. It is also necessary for us to continue to search for valuable clinicopathological indicators and individualized treatment for different patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9
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