【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3.4,3.5,2.1,3.0,3.5cm;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-6710%～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。更多还原

【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.更多还原