本文選題：浸潤性乳腺癌 + 分子分型��； 參考：《鄭州大學》2017年碩士論文

【摘要】：乳腺癌是女性常見的惡性腫瘤。近年來由于醫(yī)學科學技術的快速發(fā)展以及人們就醫(yī)意識的提高,乳腺癌的死亡率已有所降低,但是由于人們生活方式理念和生態(tài)環(huán)境的變化,乳腺癌的發(fā)病率也日益顯著增加。傳統(tǒng)的得以認可的判斷乳腺癌生物學行為和預后的指標主要有:腫瘤體積、組織學類型、淋巴結(jié)轉(zhuǎn)移情況及TNM分期等。但乳腺癌具有明顯的異質(zhì)性。即使同一組織學類型的乳腺癌在治療反應及生存期等方面存在明顯差異。因此,急需能夠反應乳腺癌異質(zhì)性的生物學標記物,以達到個體化治療的目的。隨著分子遺傳學的進展,對乳腺癌認識逐步加深,多基因檢測對于更好地理解乳腺癌異質(zhì)性和復雜的生物學行為具有十分重要的意義,基于此提出了乳腺癌分子分型這一概念,可從更深的層面揭示乳腺癌的生物學特性。不同的亞型具有不同的臨床和病理特征、不同的治療反應模式和不同的預后。基于激素受體和HER-2狀態(tài)以及增殖標記或組織學分級的臨床表征能夠相對合理地定義乳腺癌的分子亞型以指導乳腺癌患者的個體化治療。2000年美國斯坦福大學的兩位教授首次提出了分子分型的概念,并將其分為5型,基于免疫組織化學(immunohisto-chemistry,IHC)標記的分類為St Gallen專家共識在2011年推薦的,并于2013年再次確認。2013年第13屆乳腺癌St Gallen共識將乳腺癌分為四個亞型,LuminalA型:ER與PR均陽性,HER-2陰性,Ki-67低表達(㩳14%),并且多數(shù)專家認為PR㧐20%與LuminalA型密切相關。LuminalB型:(1)HER-2陰性:ER陽性,Ki-67高表達(≥14%)或PR陰性或者㩳20%;(2)HER-2陽性:ER陽性,HER-2陽性,任何Ki-67及任何PR;HER-2過表達型:ER和PR陰性,HER-2陽性�；准毎�:主要是三陰性乳腺癌(ER、PR及HER-2均為陰性)。其中后面兩型與2011年會議共識并無差別。傳統(tǒng)的臨床病理特征如腫瘤大小、淋巴結(jié)轉(zhuǎn)移情況、TNM臨床分期等指標在一定程度上也會影響患者疾病的預后。本文旨在探討乳腺癌各分子亞型的臨床病理特征及其與患者生存狀況的關系,為河南地區(qū)女性乳腺癌患者的個體化治療提供理論與實踐依據(jù)。目的本研究通過對乳腺癌的臨床病理資料的收集,旨在研究乳腺癌不同分子亞型的臨床病理特征及其與患者生存狀況的關系,為河南地區(qū)女性乳腺癌患者的個體化治療提供理論依據(jù)。方法收集538例首次于2012年1月-2012年12月在鄭州大學第一附屬醫(yī)院明確診斷為浸潤性乳腺癌的病例,采用回顧性分析的方法,將各個臨床病理資料建立數(shù)據(jù)庫,包括腫瘤大小、組織學分級、TNM臨床分期、年齡、手術方式和治療手段等。結(jié)果1.538例浸潤性乳腺癌中,132例(24.53%)為LuminalA型,211例(39.22%)為LuminalB型,83例(15.43%)為HER-2過表達型,112例(20.82%)為三陰性乳腺癌,Luminal型乳腺癌比例占絕大多數(shù)。2.不同分子分型在年齡、絕經(jīng)狀態(tài)、種族、家族史、淋巴結(jié)狀態(tài)、臨床分期、放療及手術方式方面,差異無統(tǒng)計學意義(P0.05),而在腫瘤大小、病理類型、組織學分級、化療及內(nèi)分泌治療方面差異有統(tǒng)計學意義(P0.05)。3.本研究末次隨訪日期為2017年2月17日,538例浸潤性乳腺癌病例中,死亡40例,失訪91例。四種亞型3年總生存率分別為99.2%、96.2%、90.4%和92.9%。單因素分析結(jié)果顯示腫瘤大小、臨床分期、淋巴結(jié)轉(zhuǎn)移情況、手術方式、內(nèi)分泌治療及分子分型是影響預后的因素,多因素分析結(jié)果顯示三陰型亞型、淋巴結(jié)轉(zhuǎn)移到一定數(shù)目或程度時(即N3)均是影響乳腺癌預后的因素。結(jié)論三陰性亞型、淋巴結(jié)轉(zhuǎn)移到一定數(shù)目(即N3)均是影響乳腺癌預后的因素。
[Abstract]:Breast cancer is a common malignant tumor in women. In recent years, because of the rapid development of medical science and technology and the improvement of people's medical awareness, the mortality of breast cancer has been reduced. However, the incidence of breast cancer has been greatly increased due to the changes in the concept of life style and the ecological environment. The main indicators of cancer biological behavior and prognosis are tumor volume, histological type, lymph node metastasis and TNM staging. But breast cancer has obvious heterogeneity. Even the same histological type of breast cancer has obvious differences in the treatment response and life period. Therefore, it is urgent to respond to the biology of breast cancer heterogeneity. With the development of molecular genetics, the understanding of breast cancer is gradually deepened. Multi gene detection is of great significance to better understand the heterogeneity and complex biological behavior of breast cancer. Based on this, the concept of subclassification of breast cancer is proposed, which can reveal milk from a deeper level. The biological characteristics of adenocarcinoma. Different subtypes have different clinical and pathological features, different therapeutic response patterns and different prognosis. The molecular subtypes of breast cancer can be reasonably defined to guide the individualized treatment of breast cancer patients based on the clinical characterization of hormone receptor and HER-2 status, proliferation markers or histological grading. Two professors at the Stanford University in.2000 first proposed the concept of molecular typing and divided them into 5 types. The classification of Immunohisto-chemistry, IHC markers was recommended by the St Gallen expert consensus in 2011. In 2013, the thirteenth breast cancer St Gallen consensus was reconfirmed in 2013 to divide breast cancer into four Subtype, type LuminalA: ER and PR are positive, HER-2 negative, Ki-67 low expression (? 14%), and most experts believe that PR? 20% is closely related to LuminalA type.LuminalB: (1) HER-2 negative: ER positive, Ki-67 high expression (14%) or PR negative or 20%; (2) positive HER-2 positive. Basal cell type: mainly three negative breast cancers (ER, PR and HER-2 are negative). There is no difference between the latter two and the 2011 consensus. The traditional clinicopathological features such as tumor size, lymph node metastasis, and TNM clinical staging can also affect the prognosis of the patients to a certain extent. This article is aimed at exploring milk. The clinicopathological features of the subtypes of adenocarcinoma and the relationship with the survival status of the patients provide the theoretical and practical basis for the individualized treatment of women with breast cancer in Henan. Objective this study aims to study the clinicopathological features and the clinical pathological features of the breast cancer subtypes by collecting the clinicopathological data of the breast cancer. The relationship between the living conditions of the patients was provided for the individualized treatment of women with breast cancer in Henan. Methods 538 cases of invasive breast cancer, which were first diagnosed in the First Affiliated Hospital of Zhengzhou University in January 2012, in December -2012, were collected, and a retrospective analysis was used to establish a database of various clinicopathological data. In 1.538 cases of invasive breast cancer, 132 cases (24.53%) were type LuminalA, 211 (39.22%) was LuminalB, 83 (15.43%) was HER-2 overexpressed, 112 (20.82%) was three negative breast cancer, and Luminal type breast cancer accounted for the vast majority of.2.. There was no significant difference in age, menopause, race, family history, family history, lymph node status, clinical stage, radiotherapy and surgical methods (P0.05), but the difference in tumor size, pathological type, histological grade, chemotherapy and endocrine therapy was statistically significant (P0.05) the last follow-up date of this study was 17 in February 2017, 17 In 538 cases of invasive breast cancer, 40 cases died and 91 cases were lost. The 3 year total survival rate of four subtypes was 99.2%, 96.2%, 90.4%, and 92.9%. single factor analysis showed that the tumor size, clinical stage, lymph node metastasis, operation mode, endocrine therapy and molecular typing were factors affecting the prognosis, and the results of multivariate analysis showed three. The prognostic factors of breast cancer were negative type, lymph node metastasis to a certain number or degree (N3). Conclusion three negative subtypes and a certain number of lymph nodes (N3) are all factors affecting the prognosis of breast cancer.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

【參考文獻】

相關期刊論文 前1條

1 Nahed A.Soliman;Shaimaa M.Yussif;;Ki-67 as a prognostic marker according to breast cancer molecular subtype[J];Cancer Biology & Medicine;2016年04期

，

本文編號：1953073