局部晚期乳腺癌患者腋窝淋巴结转移范围的影响因素分析
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摘要
目的:研究局部晚期乳腺癌患者腋窝淋巴结转移程度的影响因素。方法:回顾性收集我院2008年4月到2018年4月腋窝淋巴结转移≥4枚的233例乳腺癌患者的临床病理资料,比较腋窝淋巴转移N_2组(141例)和N_3组(92例)患者间的年龄、分子分型[Luminal A分子分型、人表皮生长因子受体2(human epidermal growth factor receptor2,HER-2)阳性,三阴性]、肿瘤大小、组织学分级、雌激素、孕激素受体表达、HER-2表达及Ki-67表达的差异。结果:N2组患者中肿瘤大小为T_1、T_2、T_3、T_4的百分比分别为46.1%、49.6%、2.8%、1.4%;N_3患者中肿瘤大小为T_1、T_2、T_3、T_4的百分比分别为27.2%、58.7%、13.0%、1.1%,与N_2组比较,N_3组患者的肿瘤直径更大(P=0.002)。而N_2组与N_3组患者在年龄、分子分型、组织学分级及雌激素受体、孕激素受体、HER-2、Ki-67表达方面差异均无统计学意义(P>0.05)。结论:局部晚期乳腺癌淋巴结转移范围与肿瘤大小(T分期)显著相关,而与乳腺癌患者的年龄、分子分型、组织学分级及雌激素受体、孕激素受体、HER-2、Ki-67表达无关。
Objective: To investigate the influencing factors of axillary lymph node metastasis in patients with locally advanced breast cancer. Methods: The clinical pathological data of 233 locally advanced breast cancer patients with at least 4 axillary lymph nodes metastasis from April, 2008 to April, 2018 in our hospital were collected retrospectively. The age, molecular type(luminal A/luminal B, HER-2 positive/negative, triple negative), tumor diameter, histological grade and the expression of ER/PR, HER-2, Ki-67 were compared between patients with N_2 and N_3 axillary lymph node metastasis. Results: Of the 233 locally advanced breast cancer patients, 141 patients were in Group N_2 while 92 patients were in Group N_3. The proportions of T_1, T_2, T_3 and T_4 in N_2 group were 46.1%, 49.6%, 2.8% and 1.4%, respectively, whereas that in N3 group were 27.2%, 58.7%, 13.0% and 1.1%, respectively. The diameter of tumor was larger in N_3 group than in N2 group(P=0.002). There was no statistical difference between Group N_2 and N_3 in terms of age, molecular type, histological grade, ER/PR expression, HER-2 expression and Ki-67 expression(P>0.05). Conclusions: In locally advanced breast cancer,the number of axillary lymph nodes metastasis is correlated significantly with the diameter of tumor(T stage). while no correlations with age, molecular type, histological grade, ER/PR expression, HER-2 expression and Ki-67 expression are found.
Objective: To investigate the influencing factors of axillary lymph node metastasis in patients with locally advanced breast cancer. Methods: The clinical pathological data of 233 locally advanced breast cancer patients with at least 4 axillary lymph nodes metastasis from April, 2008 to April, 2018 in our hospital were collected retrospectively. The age, molecular type(luminal A/luminal B, HER-2 positive/negative, triple negative), tumor diameter, histological grade and the expression of ER/PR, HER-2, Ki-67 were compared between patients with N_2 and N_3 axillary lymph node metastasis. Results: Of the 233 locally advanced breast cancer patients, 141 patients were in Group N_2 while 92 patients were in Group N_3. The proportions of T_1, T_2, T_3 and T_4 in N_2 group were 46.1%, 49.6%, 2.8% and 1.4%, respectively, whereas that in N3 group were 27.2%, 58.7%, 13.0% and 1.1%, respectively. The diameter of tumor was larger in N_3 group than in N2 group(P=0.002). There was no statistical difference between Group N_2 and N_3 in terms of age, molecular type, histological grade, ER/PR expression, HER-2 expression and Ki-67 expression(P>0.05). Conclusions: In locally advanced breast cancer,the number of axillary lymph nodes metastasis is correlated significantly with the diameter of tumor(T stage). while no correlations with age, molecular type, histological grade, ER/PR expression, HER-2 expression and Ki-67 expression are found.
引文
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[16]刘铭,张明军,杨育才,等.保乳治疗乳腺癌患者临床病理特征与预后的相关性[J].安徽医学,2019,40(1)9-13.
[2]van Calster B,Vanden Bempt I,Drijkoningen M,et al.Axillary lymph node status of operable breast cancers by combined steroid receptor and HER-2 status:triple positive tumours are more likely lymph node positive[J].Breast Cancer Res Treat.2009 Jan;113(1):181-187.
[3]庞琼,南昊成,马婕群,等.不同分子亚型乳腺浸润性导管癌的临床特征与预后分析[J].临床肿瘤学杂志2015,21(2):132-136.
[4]赵永富,姚永庭.青年女性乳腺癌分子分型及其与临床病理特征的关系[J].中国妇幼健康研究,2015,26(6):1185-1188.
[5]王盛,李娜.乳腺浸润性导管癌最新分子分型及其临床病理特征分析[J].中国社区医师,2015,29(8):110-112.
[6]曹静,吕志排,雷冬梅,等.乳腺癌的分子分型与临床病理特征及预后的关系[J].诊断学理论与实践,2013,12(4):466-469.
[7]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志2017,27(9):695-759.
[8]Prat A,Cheang MC,Martín M,et al.Prognostic significance of progesterone receptor-positive tumor cells within immunohistochemically defined luminal A breast cancer[J].J Clin Oncol,2013,31(2):203-209.
[9]Goldhirsch A,Winer EP,Coates AS,et al.Personalizing the treatment of women with early breast cancer:highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J].Ann Oncol,2013,24(9):2206-2223.
[10]张绪良,黄绪群.分子分型在乳腺癌辅助治疗选择中的临床研究[J].现代肿瘤医学,2015,23(19):2747-2750.
[11]Inic Z,Zegarac M,Inic M,et al.Difference between Luminal A and Luminal B Subtypes According to Ki-67Tumor Size,and Progesterone Receptor Negativity Providing Prognostic Information[J].Clin Med Insights Oncol,2014,8:107-111.
[12]王芳,郝春芳,贾勇圣,等.205例初治转移性乳腺癌的临床病理特点和生存分析[J].中国肿瘤临床,2014,52(17)1103-1107.
[13]沈镇宙,邵志敏.乳腺肿瘤学[M].上海科学技术出版社2005.
[14]Silverstein MJ,Skinner KA,Lomis TJ.Predicting axillary nodal positivity in 2282 patients with breast carcinoma[J].World J Surg,2001,25(6):767-772.
[15]周淑玲,杨文涛.三阴性乳腺癌的临床病理特征及分子研究进展[J].中国癌症杂志,2013,23(8):603-608.
[16]刘铭,张明军,杨育才,等.保乳治疗乳腺癌患者临床病理特征与预后的相关性[J].安徽医学,2019,40(1)9-13.