首页|雌激素受体不同表达状态的人表皮生长因子受体2阴性乳腺癌患者的临床病理特征及其预后分析

雌激素受体不同表达状态的人表皮生长因子受体2阴性乳腺癌患者的临床病理特征及其预后分析

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目的 了解雌激素受体(estrogen receptor,ER)不同表达状态的人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阴性乳腺癌患者的临床病理特征及预后情况.方法 回顾性收集2017年1月1日至2019年12月31日期间西南医科大学附属医院收治且符合纳入和排除标准的HER2阴性乳腺癌患者,根据ER表达状态将患者分为ER阴性(ER表达阳性率<1%)组、ER低表达(ER表达阳性率1%~10%)组、ER表达阳性率>10%组3组,比较3组患者的临床病理特征差异、治疗方式及预后(预后指标为总生存和无病生存)情况,并采用Cox比例风险回归模型分析影响ER低表达乳腺癌患者复发转移的风险因素.结果 本研究共纳入610例HER2阴性乳腺癌患者,其中ER阴性组130例、ER低表达组48例、ER表达阳性率>10%组432例,采用Bonferroni法校正检验水准的事后两两比较发现,ER阴性组和ER低表达组较ER表达阳性率>10%组患者的组织学分级更晚(P<0.001、P=0.023)、Ki-67表达更高(P<0.001、P<0.001);ER阴性组接受化学药物治疗的比例高于ER表达阳性率>10%组(x2=10.310,P=0.001),而ER低表达组分别与ER阴性组和ER表达阳性率>10%组在是否行化学药物治疗上差异无统计学意义(Fisher确切概率法,P=1.000;x2=3.585,P=0.058);ER低表达组接受内分泌治疗的比例高于ER阴性组(x2=36.333,P<0.001)而低于ER表达阳性率>10%组(x2x=246.996,P<0.001).3组患者的无病生存曲线比较差异有统计学意义(x2=46.805,P<0.001);总生存曲线和无病生存曲线在ER阴性组和ER低表达组之间比较差异均无统计学意义(Two-stage检验,P=0.786;x2=1.141,P=0.286),而它们在ER表达阳性率>10%组明显优于ER阴性组(x2=10.137、P=0.001;x2=39.344、P<0.001)和ER低表达组(x2=4.075、P=0.044;x2=31.911、P<0.001).经多因素Cox比例风险回归模型分析结果发现,N1、N2相对于N0[RR(95%CI)=7.740(1.939,30.897),P=0.004;RR(95%CI)=9.513(1.990,45.478),P=0.005]以及 T3 相较 T1[RR(95%CI)=27.357(2.188,342.041),P=0.010]患者增加ER低表达HER2阴性乳腺癌患者复发转移概率.结论 从本研究分析结果看,ER低表达与ER阴性表达的HER2阴性乳腺癌患者在临床病理特征方面未见有统计学的差异,二者的预后方面均较ER表达阳性率>10%的HER2阴性乳腺癌患者差,淋巴结转移、肿瘤较大增加ER低表达HER2阴性乳腺癌患者复发转移的风险.
Analysis of clinicopathologic features and prognostic factors of negative human epidermal growth factor receptor 2 breast cancer patients with different expression status of estrogen receptor
Objective To analyze the clinicopathologic characteristics and prognosis of human epidermal growth factor receptor 2(HER2)-negative breast cancer patients with different expression status of estrogen receptor(ER).Methods The patients with HER2-negative breast cancer met the inclusion and exclusion criteria and were treated in the Affiliated Hospital of Southwest Medical University from January 1,2017 to December 31,2019 were retrospectively collected,and then were assigned into 3 groups according to the ER expression status:ER-negative(ER expression positive rate<1%)group,ER-low expression(ER expression positive rate 1%-10%)group,and ER expression positive rate>10%group.The differences of clinicopathologic characteristics,therapy,and prognosis among the 3 groups were compared.And the risk factors affecting recurrence and metastasis of patients with ER-low expression were analyzed by Cox proportional hazards regression model.Results A total of 610 patients with HER2-negative breast cancer were included in this study,including 130 patients in the ER-negative group,48 patients in the ER-low expression group,and 432 patients in the ER expression positive rate>10%group.The Bonferroni method was used to correct the test level after pairwise comparison,it was found that the histological grade was later(P<0.001,P=0.023)and the Ki-67 expression was higher(P<0.001,P=0.023)in the ER-negative group and ER-low expression group as compared with the ER expression positive rate>10%group;The proportion of the patients receiving chemotherapy in the ER-negative group was higher than that of the ER expression positive rate>10%group(x2=10.310,P=0.001),while which had no statistical difference between the ER-low expression group and the ER-negative group or the ER expression positive rate>10%group(Fisher exact probability method,P=1.000;x2=3.585,P=0.058);The proportion of patients receiving endocrine therapy in the ER-low expression group was higher than that in the ER-negative group(x2=36.333,P<0.001)and lower than the ER expression positive rate>10%group(x2=246.996,P<0.001).The difference in disease-free survival(DFS)curves among 3 groups was statistically significant(x2=46.805,P<0.001);There were no statistical differences in the overall survival(OS)curve and DFS curve between the ER-negative group and the ER-low expression group(Two stage test,P=0.786;x2=1.141,P=0.286),and which in the ER expression positive rate>10%group were significantly better than thoses in the ER-negative group(x2=10.137,P=0.001;x2=39.344,P<0.001)and the ER-low expression group(x2=4.075,P=0.044;x2=31.911,P<0.001).The results of multivariate Cox proportional hazards regression analysis showed that N1 and N2[N0 as reference:RR(95%CI)=7.740(1.939,30.897),P=0.004;RR(95%CI)=9.513(1.990,45.478),P=0.005)and T3[T1 as reference:RR(95%CI)=27.357(2.188,342.041),P=0.010]increased the probabilities of recurrence and metastasis HER2-negative breast cancer patients with ER-low expression.Conclusions According to results of this study,patients with HER2-negative breast cancer showed certain differences in histological grade and Ki-67 expression among patients with three different ER expression status,but no statistical difference is found between ER-low expression and ER-negative breast cancer,and the prognoses of both are worse than that of ER expression positive rate>10%breast cancer patients.Lymph node metastasis and larger tumor are risk factors affecting recurrence and metastasis in ER-low expression breast cancer patients.

estrogen receptor low expressionhuman epidermal growth factor receptor 2 negativebreast cancerclinicopathologic featureprognosis

郭晓蝶、吴佳星、官桂林、左怀全

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西南医科大学附属医院四川省妇科与乳腺疾病中心(乳腺外科)(四川泸州 646000)

雌激素受体低表达 人表皮生长因子受体2阴性 乳腺癌 临床病理特征 预后

2024

中国普外基础与临床杂志
四川大学华西医院

中国普外基础与临床杂志

CSTPCD
影响因子:0.858
ISSN:1007-9424
年,卷(期):2024.31(1)
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