| 摘要: |
| 目的 探讨围绝经期雌激素受体（ER）和/或孕激素受体（PR）阳性及人类表皮生长因子受体2（HER2）阴性（ER/PR+HER2-）浸润性乳腺癌患者的临床病理特征及预后。方法 选择2009年1月至12月上海交通大学医学院附属第九人民医院黄浦分院收治的335例ER/PR+HER2-浸润性乳腺癌患者作为研究对象，根据月经状态将其分为绝经前组（<40岁，23例）、围绝经期组（40～60岁，228例）和绝经后组（>60岁，84例），比较3组患者的临床病理特征及预后情况，并通过单因素和多因素Cox回归分析围绝经期ER/PR+HER2-浸润性乳腺癌患者预后的危险因素。结果 不同月经状态ER/PR+HER2-浸润性乳腺癌患者肿瘤T分期、N分期、TNM分期、组织学分级、组织学类型、淋巴血管浸润情况、PR表达水平差异均无统计学意义（P均>0.05）。Ki-67、ER、P53表达水平在3组患者间差异均有统计学意义（P均<0.01），围绝经期和绝经前组患者Ki-67阳性细胞百分比≥60%者和≥20%者占比均高于绝经后组，绝经前、围绝经期、绝经后组患者的ER表达水平依次增高，围绝经期和绝经前组患者的P53表达水平均高于绝经后组。绝经前、围绝经期和绝经后组患者生存率分别为87.0%（20/23）、92.1%（210/228）和91.7%（77/84），Kaplan-Meier生存曲线分析显示3组间差异无统计学意义（P>0.05）。多因素Cox回归分析结果显示，淋巴结转移、Ki-67阳性细胞百分比≥60%、PR低表达是围绝经期ER/PR+HER2-浸润性乳腺癌患者预后的独立影响因素（HR=2.43、3.45、0.27，P均<0.05）。结论 围绝经期ER/PR+HER2-浸润性乳腺癌有其独特的临床病理特征，但不同月经状态下患者的预后无明显差异。淋巴结转移、Ki-67阳性细胞百分比≥60%、PR低表达是围绝经期ER/PR+HER2-浸润性乳腺癌患者预后的独立影响因素。 |
| 关键词: 乳腺肿瘤 围绝经期 临床病理特征 预后 雌激素受体 孕酮受体 |
| DOI：10.16781/j.0258-879x.2021.05.0475 |
| 投稿时间：2021-02-21修订日期：2021-04-16 |
| 基金项目:上海市黄浦区卫生健康委员会课题（2019BJ04），上海市科学技术委员会课题（14411972400）. |
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| Clinicopathological features and prognosis of perimenopausal patients with ER/PR+HER2- invasive breast cancer |
| XIE Yi-qun1,LI Xi-zhou2,LI Li2*,LI Heng-yu2* |
(1. Department of Breast Surgery, Huangpu Branch of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;
2. Department of General Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To investigate the clinicopathological features and prognosis of perimenopausal patients with estrogen receptor (ER) and/or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 (HER2) negative (ER/PR+HER2-) invasive breast cancer. Methods A total of 335 patients with ER/PR+HER2- invasive breast cancer who were admitted to the Huangpu Branch of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from Jan. to Dec. 2009 were included and divided into premenopausal group (<40 years, 23 cases), perimenopausal group (40-60 years, 228 cases) and postmenopausal group (>60 years, 84 cases) according to the menopausal statuses. The clinicopathological features and prognosis of the patients in the 3 groups were compared, and the prognostic risk factors for the patients were investigated using univariate and multivariate Cox regression analyses. Results There were no significant differences in tumor T stage, N stage, TNM stage, histological grade, histological classification, lymphovascular invasion or PR expression level of the ER/PR+HER2- invasive breast cancer patients with different menopausal statuses (all P>0.05). There were significant differences in the expression of Ki-67, ER, and P53 among the 3 groups (all P<0.01). The proportions of patients with Ki-67 positive cells ≥ 60% and ≥ 20% were higher in the perimenopausal and premenopausal groups than in the postmenopausal group. The expression levels of ER in the premenopausal, perimenopausal and postmenopausal groups were increased in turn. The expression levels of P53 in the perimenopausal and premenopausal groups were higher than that in the postmenopausal group. The survival rates of the premenopausal, perimenopausal and postmenopausal patients were 87.0% (20/23), 92.1% (210/228) and 91.7% (77/84), respectively. The Kaplan-Meier survival curve analysis showed that there was no significant difference among the 3 groups (P>0.05). The multivariate Cox regression analysis showed that lymph node metastasis, Ki-67 positive cells ≥ 60% and low PR expression were independent prognostic factors for perimenopausal patients with ER/PR+HER2- invasive breast cancer (hazard ratio=2.43, 3.45, 0.27, all P<0.05). Conclusion Perimenopausal ER/PR+HER2- invasive breast cancer has its unique clinicopathological features, but there is no significant difference in the prognosis of ER/PR+HER2- invasive breast cancer patients with different menopausal statuses. Lymph node metastasis, Ki-67 positive cells ≥ 60%, and low PR expression are independent prognostic factors for perimenopausal patients with ER/PR+HER2- invasive breast cancer. |
| Key words: breast neoplasms perimenopause clinicopathological features prognosis estrogen receptor progesterone receptor |
