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目的 :探讨不同分子亚型乳腺浸润性小叶癌(invasive lobular carcinoma,ILC)患者的临床病理特征及预后相关因素。方法 :收集天津医科大学肿瘤医院2003年1月1日—2012年12月31日收治的381例乳腺ILC患者的临床病理资料,基于免疫组织化学检测结果进行分子分型[Luminal A型、Luminal B型、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)过表达型和三阴型],比较不同分子亚型乳腺ILC患者的临床病理特征及预后差异,以及影响预后的相关因素。结果 :不同分子亚型乳腺ILC所占比例存在显著差异,其中以Luminal B型所占比例最高(66.4%),其余依次为Luminal A型、三阴型和HER2过表达型(分别为16.8%、11.3%和5.5%)。不同分子亚型乳腺ILC患者的发病年龄、绝经状态和腋窝淋巴结转移状态存在显著差异(P值均<0.05)。单因素分析结果显示,肿瘤大小、腋窝淋巴结转移状态、临床分期、分子亚型、手术方式、术后放疗和内分泌治疗均与乳腺ILC患者的预后相关(P值均<0.05)。Luminal A型的5年总生存率为100.0%,Luminal B型为91.2%,明显高于HER2过表达型(55.6%)和三阴型(50.9%)。多因素分析结果显示,肿瘤大小、分子亚型、腋窝淋巴结转移状态以及内分泌治疗均是乳腺ILC患者预后的独立影响因素(P值均<0.05)。结论 :乳腺ILC分子亚型对于预测其预后具有重要的意义,需要进一步研究以指导临床上ILC患者的精准化个体治疗。
Objective: To investigate the clinicopathological features and prognostic factors of different subtypes of breast invasive lobular carcinoma (ILC). Methods: Clinicopathological data of 381 cases of breast ILC patients who were admitted to Tumor Hospital of Tianjin Medical University from January 1, 2003 to December 31, 2012 were collected for molecular typing based on the results of immunohistochemistry [Luminal A type, Luminal B Type, human epidermal growth factor receptor 2 (HER2) overexpression and triple negative], to compare the clinicopathological features and prognosis of different molecular subtypes of breast ILC patients, as well as related factors that affect the prognosis . Results: There were significant differences in the proportion of different molecular subtypes of breast ILC, among which Luminal B accounted for the highest proportion (66.4%), followed by Luminal A, Sanyin and HER2 overexpression (16.8% 11.3% and 5.5%). Age, menopausal status and axillary lymph node metastasis status of breast cancer patients with different molecular subtypes were significantly different (all P <0.05). Univariate analysis showed that tumor size, axillary lymph node metastasis, clinical stage, molecular subtypes, surgical procedures, postoperative radiotherapy and endocrine therapy were all associated with the prognosis of patients with ILC (all P <0.05). The 5-year overall survival rate was 100.0% for Luminal A type and 91.2% for Luminal B type, which was significantly higher than that of HER2 overexpression (55.6%) and triple negative (50.9%). Multivariate analysis showed that tumor size, molecular subtypes, axillary lymph node metastasis and endocrine therapy were independent prognostic factors in patients with breast ILC (all P <0.05). Conclusion: The molecular subtypes of breast ILC are important for predicting their prognosis. Further study is needed to guide the accurate individual treatment of ILC patients in clinic.