本文選題：乳腺癌 + 同期腋窩淋巴結(jié)轉(zhuǎn)移��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:乳腺癌病灶中激素受體和HER-2及ki-67等標(biāo)志物的表達(dá)水平是乳腺癌分型及全身治療方案制定的指導(dǎo)性指標(biāo)。以往我們認(rèn)為復(fù)發(fā)/轉(zhuǎn)移灶與原發(fā)腫瘤具有一致的分子分型,然而對轉(zhuǎn)移/復(fù)發(fā)灶重新進(jìn)行免疫組化評估發(fā)現(xiàn)結(jié)果與原發(fā)病灶存在一定的差異,對術(shù)后出現(xiàn)復(fù)發(fā)/轉(zhuǎn)移的乳腺癌患者再次進(jìn)行免疫組化評估是目前較為普遍的做法。而對于同期同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移灶是否需要單獨進(jìn)行免疫組化評估目前尚無統(tǒng)一意見。方法:本文收集了 2015年1月1日至2017年2月28日在浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院經(jīng)治的病理學(xué)確診的除同期同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移外無他處轉(zhuǎn)移的女性乳腺癌患者的臨床病理資料。通過比較乳腺原發(fā)腫塊及同期同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移灶的ER、PR、Her-2及ki-67的表達(dá)情況,統(tǒng)計其差異性與一致性。結(jié)果采用SPSS Statistics 19.0軟件分析,P0.05表示有統(tǒng)計學(xué)意義。結(jié)果:1.在研究的95例患者中,ER在原發(fā)灶及同期同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移灶中的表達(dá)呈現(xiàn)高度一致性,即所有患者的ER表達(dá)在原發(fā)和腋窩淋巴結(jié)中一致。PR由原發(fā)灶陽性轉(zhuǎn)變?yōu)榱馨徒Y(jié)轉(zhuǎn)移灶陰性率為12.0%,由原發(fā)灶陰性轉(zhuǎn)變?yōu)殛栃月蕿?1.5%,總變化率為12.6%。Her-2結(jié)果完備的75例患中,Her-2由原發(fā)灶陽性轉(zhuǎn)變?yōu)橐父C淋巴結(jié)轉(zhuǎn)移灶陰性率為4.0%,由陰性轉(zhuǎn)變?yōu)殛栃月蕿?.0%,Her-2總變化率為4.0%。93例ki-67結(jié)果完備的患者中,ki-67由原發(fā)灶陽性轉(zhuǎn)變?yōu)橐父C淋巴結(jié)轉(zhuǎn)移灶陰性率為19.7%,由陰性轉(zhuǎn)變?yōu)殛栃月蕿?5.6%,總變化率為18.3%。上述表達(dá)變化無統(tǒng)計學(xué)差異(P0.05)。2.按年齡、腫瘤大小、腋窩淋巴結(jié)轉(zhuǎn)移個數(shù)分組分別將ER、PR、Her-2、ki-67進(jìn)行不一致率分析,均無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:1.ER、PR、Her-2、ki-67在乳腺癌原發(fā)灶與同期同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移灶中的表達(dá)一致性較好,但均在不同程度上存在一定差異性,但差異無統(tǒng)計學(xué)意義且年齡、腫瘤大小、腋窩淋巴結(jié)轉(zhuǎn)移個數(shù)對這些指標(biāo)的變化無影響。2.PR、Her-2、ki-67均有從陽性轉(zhuǎn)為陰性、陰性轉(zhuǎn)為陽性的可能,而這些指標(biāo)存在變化的情況對于治療方案的制定可能更有意義,在臨床過程中,仍建議行全面的病理檢查,可能對于部分患者增加了治療獲益的可能性,對于標(biāo)志物表達(dá)的變化的預(yù)測治療療效的作用仍需長期隨訪證實,期待大樣本隨訪結(jié)果。
[Abstract]:Background: the expression level of hormone receptor, HER-2 and ki-67 in breast cancer focus is the guiding index of breast cancer classification and systemic therapy. In the past, we thought that the recurrence / metastasis had the same molecular classification with the primary tumor. However, the immunohistochemical evaluation of the metastasis / recurrence was different from the primary tumor. It is a common practice to reevaluate the recurrence / metastasis of breast cancer by immunohistochemistry. However, there is no uniform opinion as to whether the ipsilateral axillary lymph node metastases need to be assessed by immunohistochemistry alone. Methods: from January 1, 2015 to February 28, 2017, a pathologically diagnosed female breast cancer patient with no metastasis other than ipsilateral axillary lymph node metastasis was collected from the second affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, from January 1, 2015 to February 28, 2017. The clinicopathological data of the patients were analyzed. By comparing the expression of ERP PRN Her-2 and ki-67 in primary breast masses and axillary lymph node metastases at the same time, the difference and consistency were analyzed. Results SPSS Statistics 19.0 software was used to analyze the statistical significance. The result is 1: 1. The expression of ER in primary and ipsilateral axillary lymph node metastasis was highly consistent in 95 patients. That is, ER expression in all patients was consistent in primary and axillary lymph nodes. PR was changed from primary tumor positive to lymph node metastasis negative rate 12.0, from primary tumor negative to positive rate 11.5. The total change rate was 12.6.Her-2 complete 75 cases. The positive rate of Her-2 from primary tumor to axillary lymph node metastasis was 4.0, and the total change rate of Her-2 from negative to positive was 4.00.93 patients with complete ki-67 results changed from positive primary focus to negative metastasis of axillary lymph node. The sex rate was 19.7g, the change rate from negative to positive was 15.6g, the total change rate was 18.3%. There was no statistical difference in the expression of P0.05. 2. According to age, tumor size and number of axillary lymph node metastasis, the inconsistency rate of ERV PRP Her-2OKi-67 was analyzed, and there was no statistical difference (P 0.05). Conclusion: 1. The expression of Her-2ki-67 in primary breast cancer is consistent with that in axillary lymph node metastasis in the same period, but there are some differences to some extent, but there is no significant difference in age, tumor size, and age, but there is no significant difference in the expression of Her-2ki-67 in primary and ipsilateral axillary lymph node metastases of breast cancer. The number of axillary lymph node metastasis had no effect on the changes of these indexes. 2. The number of axillary lymph node metastasis had no effect on the changes of these indexes. 2. All of the changes in the number of axillary lymph node metastasis had the possibility of changing from positive to negative and negative to positive. However, the changes of these indexes might be more significant for the formulation of treatment plan. It is suggested that comprehensive pathological examination may increase the possibility of therapeutic benefit for some patients, and the effect of predicting therapeutic effect on the change of marker expression still needs to be confirmed by long-term follow-up, and a large sample of follow-up results are expected.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

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