基底细胞样乳腺癌临床病理学特点及其意义
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Clinicopathological features of basal-like breast carcinoma and its significance
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    摘要:

    目的 探讨基底细胞样乳腺癌的临床病理学特点及意义。方法 采用免疫组织化学2步法, 检测E-钙黏素、基质金属蛋白酶(MMP-7)、p53、增殖细胞核抗原Ki-67在22例腔上皮A型、23例腔上皮B型、20例基底细胞样型、23例人表皮生长因子2(HER2)高表达型、17例正常乳腺表型乳腺癌组织中的表达情况, 同时对临床病理特征进行统计学分析, 随访6~60个月。结果 腔上皮A型、腔上皮B型、基底细胞样型、HER2高表达型、正常乳腺表型乳腺癌平均发病年龄分别为54.5, 51.1, 48.8, 52.0, 56.0岁, 其中基底细胞样型中老年女性占20.0%(5/20); 肿物平均大小分别为3.4, 3.5, 2.1, 3.0, 3.5 cm; 5年无瘤生存率分别为78.3%(17/22), 73.9%(17/23), 40.0%(8/20), 65.2%(15/23), 70.6%(12/17), 基底细胞样型低于其余4型(P<0.05)。5型乳腺癌中p53蛋白阳性率分别为22.7%, 26.1%, 60.0%, 56.5%, 23.5%, 基底细胞样型和HER2高表达型p53蛋白阳性率高(P<0.05); E-钙黏素阳性率分别为100.0%, 100.0%, 80.0%, 100.0%, 100.0%, 基底细胞样型低于其余四型(P<0.05); MMP-7阳性率分别为40.9%, 52.2%, 85.0%, 69.6%, 64.7%, 基底细胞样型高于腔上皮A, 腔上皮B型(P<0.05); Ki-67<10%阳性率分别为59.1%, 39.1%, 25.0%, 30.4%, 29.4%, Ki-67 10%~30%阳性率分别为36.4%, 52.2%, 40.0%, 52.2%, 58.8%, Ki-67≥30%阳性率分别为4.5%, 8.7%, 35.0%, 17.4%, 11.8%, 说明基底细胞样型增殖指数显著增高(P<0.01)。多因素分析表明, 基因分型不是乳腺癌预后的独立因素(P>0.05)。结论 基因分型乳腺癌中, 基底细胞样型平均发病年龄较小, 通常为绝经期前; 基底细胞样型乳腺癌侵袭转移力高、细胞增殖更旺盛、易发生p53基因突变, 且5年生存率最低。

    Abstract:

    Objective To investigate the clinicopathological features of basal-like breast carcinoma and its significance. Methods A total of 105 patients with breast carcinoma were enrolled in this study, including 22 cases of luminal type A, 23 of luminal type B, 20 of basal-like, 23 of HER2-enriched and 17 of normal breast-like. The expressions of p53, E-cadherin, matrix metalloproteinase-7(MMP-7), Ki-67 in tumour cells were examined immunohistochemically. The clinicopathological features were analyzed statistically. The follow-up period ranged from 6 to 60 months. Results For the five breast tumor subtypes, sequentially luminal A, luminal B, basal-like, HER2- over-expression, and normal breast-like, the mean age was 54.5, 51.1, 48.8, 52.0 and 56.0 years respectively, and the rate of elderly was 20.0%(5/20) in basal-like tumor; the mean tumor size was 3.4, 3.5, 2.1, 3.0 and 3.5cm respectively; the 5-year tumor-free survival rate was 78.3%(17/22), 73.9%(17/23), 40.0%(8/20), 65.2%(15/23) and 70.6%(12/17) respectively, significantly lower in basal-like subtype(P<0.05); p53 positive expression rate was 22.7%, 26.1%, 60.0%, 56.5% and 23.5% respectively, significantly higher in basal-like and HER2-over-expression subtypes (P<0.05); E-cadherin positive expression rate was 100.0%, 100.0%, 80.0%, 100.0%, and 100.0% respectively, lower in basal-like subtype(P<0.05); MMP-7 positive expression rate was 40.9%, 52.2%, 85.0%, 69.6% and 64.7% respectively, higher in basal-like subtype than in luminal A and B subtypes(P<0.05). Ki-67 index was divided into three levels (<10%, 10%-30%, ≥30%) . The positivity rate of Ki-67<10% was 59.1%, 39.1%, 25.0%, 30.4% and 29.4% respectively; that of Ki-67 10%-30% was 36.4%, 52.2%, 40.0%, 52.2% and 58.8% respectively; that of Ki-67≥30% was 4.5%, 8.7%, 35.0%, 17.4% and 11.8% respectively. The basal-like subtype had higher proliferation index in all three levels(P<0.01). Log-rank analysis suggested that the genotyping was not related to the prognosis of the breast carcinoma(P>0.05). Conclusions Compared to other subtypes, basal-like breast carcinoma is usually found in younger patients before menopause. The basal-like breast carcinoma has a poor prognosis and high invasion ability and high mutation rate of p53.

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高 雪, 关宏伟, 王洪江, 等.基底细胞样乳腺癌临床病理学特点及其意义[J].中华老年多器官疾病杂志,2011,10(6):519~523

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