乳腺癌首发肺转移38 例临床病理特征及预后因素
| 作者: |
1张和军,
1沈武成,
1朱伟峰,
1陈刚,
2吴秀凤,
1夏言,
1许春伟,
3崔兆磊,
1胡丹
1 福建医科大学附属肿瘤医院，福建省肿瘤医院病理科，福州 350014 2 福建医科大学附属肿瘤医院，福建省肿瘤医院乳腺外科，福州 350014 3 福建医科大学附属肿瘤医院，福建省肿瘤医院检验科，福州 350014 |
| 通讯: |
胡丹
Email: 54511322@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.10.005 |
| 基金: | 福建省自然科学基金 (2016J01508，2018J01264)；福建省卫生厅中青年骨干人才培养项目 (2016-ZQN-17)；福建省医学创新课题 (2017-CXB-2)。 |
摘要
目的：比较乳腺癌原发灶与首发肺转移灶的临床病理特征，探讨乳腺癌首发肺转移病例的临床病理特点与预后的关系。方法：收集38例乳腺癌首发肺转移的病例临床资料及预后，采用免疫组织化学检测雌激素受体(estrogen receptor，ER)、孕激素受体(progesterone receptor，PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2，HER2)，Ki-67，甲状腺转录因子-1(thyroid transcription factor-1，TTF-1)，GATA3在肺转移灶的表达。结果：38例首发肺转移乳腺癌病理类型浸润性导管癌37例，黏液癌1例。组织学分级I级4例，II级28例，III级6例；分子分型luminal A型患者21例，luminal B型患者7例，HER-2过表达型3例，三阴性乳腺癌(triple-negative breast cancer，TNBC)7例。TNM分期：I期10例，II期14例，III期13例，IV期1例。肺转移灶各组免疫组织化学指标阳性例数为ER 26， PR 22，HER-2 6，TTF-1 0，GATA3 37，转移灶的组织学分级和Ki-67指数均高于原发灶(P<0.05)。 Kaplan-Meier生存曲线显示HER2过表达与TNBC3年和5年无病生存期低于luminal型(P<0.05)。结论：乳腺癌首发肺转移患者转移灶与原发灶病理类型相同，但组织学分级和Ki-67指数高于原发灶，分子分型可发生改变。与luminal型患者比较，HER2过表达与TNBC患者3年和5年无病生存期更短。联合检测GATA3，TTF-1，ER，PR，HER-2表达有助于乳腺癌肺转移的鉴别诊断。
关键词：
乳腺癌；肺转移；预后；分子分型
Clinicopathological features and prognostic factor analysis for 38 breast cancer patients with first-episode lung metastasis
CorrespondingAuthor: HU Dan Email: 54511322@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.10.005
Foundation: This work was supported by the Natural Science Foundation of Fujian Province (2016J01508, 2018J01264); Fujian Provincial Health and Family Planning Research Talent Training Program (2016-ZQN-17); Medical Innovation Program of Fujian Province (2017-CXB-2)
Abstract
Objective: To compare the clinicopathological features of primary tumors and the lung metastatic tumors, and analyze the relationship between clinicopathological features and prognosis in patients with first-episode lung metastasis of breast cancer. Methods: Thirty-eight breast cancer patients with first-episode lung metastasis were identified. Immunohistochemical staining for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, thyroid transcription factor-1 (TTF-1), GATA-3 were performed on the primary tumors and the lung metastatic tumors. Results: Thirty-seven of the 38 primary tumors were invasive ductal carcinoma, one was mucinous carcinoma. Carcinomas of nuclear Grade 3 were more frequent than those of Grade 1 or 2. Patients with Luminal A were more than those of Luminal B, HER2-overexpression and triple-negative breast cancer (TNBC). Twenty-six cases of ER, 22 PR, 6 HER2, 0 TTF-1, and 37 GATA-3 were found in the metastatic foci of lung. The histologic grade and Ki-67 index in metastatic tumor were higher than those in primary foci. In the patients with HER2 overexpression and TNBC, the disease-free survival (DFS) with lung metastasis was shorter than those with luminal subtypes. Conclusion: Metastatic tumors were similar to those of primary lesions in histological types, but their histological grade and Ki-67 index were higher than primary tumors. Compared with patients with luminal subtypes, HER2 overexpression and TNBC subtypes tend to associate with lung metastasis at the early stage. Detection of GATA-3 combined with TTF-1, ER, PR, and HER2 could be used in distinguishing the lung metastasis of breast cancer.
Keywords：
breast neoplasms; lung metastasis; prognosis; molecular subtype