本文選題：原發(fā)性乳腺癌 + 轉(zhuǎn)移性乳腺癌��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:乳腺癌是女性最常見的惡性腫瘤之一,流行病學(xué)數(shù)據(jù)表明其發(fā)病率逐年上升。晚期轉(zhuǎn)移性乳腺癌(metastatic breast cancer,MBC)的治療仍遠(yuǎn)未達(dá)到理想水平,應(yīng)用目前常規(guī)治療手段如化療、放療、內(nèi)分泌治療及靶向治療仍難以治愈,治療后平均中位存活時(shí)間為2-3年,僅少數(shù)患者可長期生存。Ⅳ期乳腺癌患者治療原則是以內(nèi)科藥物治療為主的綜合治療。目前,轉(zhuǎn)移性乳腺癌的治療主要是根據(jù)腫瘤細(xì)胞表面ER、PR和HER-2三種受體的不同表達(dá)情況,從而進(jìn)一步選擇相應(yīng)的內(nèi)分泌、化療、靶向及相互聯(lián)合治療等不同的治療策略。已有多個(gè)回顧性研究報(bào)導(dǎo)了與乳腺癌原發(fā)灶相比,乳腺癌復(fù)發(fā)/轉(zhuǎn)移灶中存在3種受體表達(dá)不一致的現(xiàn)象;甚至同一乳腺癌患者不同復(fù)發(fā)/轉(zhuǎn)移部位之間、雙側(cè)乳腺癌病灶之間存在ER、PR和HER-2三種受體的異質(zhì)性表達(dá)。上述現(xiàn)象進(jìn)一步影響了患者的預(yù)后及治療方案的選擇。目的:探討本中心乳腺癌復(fù)發(fā)/轉(zhuǎn)移病灶與原發(fā)病灶之間3種受體表達(dá)不一致的情況。進(jìn)一步探討患者年齡、出現(xiàn)病灶復(fù)發(fā)/轉(zhuǎn)移的間隔時(shí)間、先前治療如內(nèi)分泌、化療及靶向治療等因素與3種受體表達(dá)不一致是否相關(guān)。方法:回顧性分析2013.9至2016.12月在浙江大學(xué)附屬邵逸夫醫(yī)院就診的晚期乳腺癌患者,分析其原發(fā)灶手術(shù)標(biāo)本與復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移標(biāo)本中腫瘤細(xì)胞表面ER、PR和HER-2的表達(dá)情況,回顧性分析其與患者年齡、出現(xiàn)病灶復(fù)發(fā)/轉(zhuǎn)移的間隔時(shí)間、先前治療如內(nèi)分泌、化療及靶向治療等因素的相關(guān)性。結(jié)果:本研究共分析了 96例接受再次及多次活檢的晚期乳腺癌患者病灶腫瘤細(xì)胞表面3種受體表達(dá)的情況。96例晚期乳腺癌患者就診時(shí)的平均年齡為49歲(33歲～76歲)。所有患者原發(fā)乳腺癌均進(jìn)行了乳腺癌根治或改良根治術(shù),96例患者術(shù)后進(jìn)行了相應(yīng)的輔助治療如放療、內(nèi)分泌治療和化療治療,6例患者術(shù)后曾行赫賽汀靶向治療。ER、PR和HER2在原發(fā)乳腺腫瘤病灶與復(fù)發(fā)轉(zhuǎn)移灶中存在表達(dá)不一致性的現(xiàn)象,不一致率分別為20%、34%、13%。患者的年齡、出現(xiàn)復(fù)發(fā)/轉(zhuǎn)移間隔時(shí)間、先前治療如內(nèi)分泌治療、化療及靶向治療等因素與3種受體表達(dá)不一致無明顯相關(guān)。因發(fā)現(xiàn)乳腺原發(fā)腫瘤與轉(zhuǎn)移灶中相關(guān)受體表達(dá)不一致情況后,導(dǎo)致的潛在治療方案調(diào)整率約為23%。結(jié)論:研究發(fā)現(xiàn)同一乳腺癌患者中乳腺原發(fā)灶與復(fù)發(fā)/轉(zhuǎn)移灶之間存在ER、PR和HER2三種受體表達(dá)不一致性的現(xiàn)象,可能會(huì)進(jìn)一步影響患者的后續(xù)治療方案。因此,研究結(jié)論認(rèn)為在臨床可能的情況下,應(yīng)對(duì)晚期乳腺癌患者復(fù)發(fā)或轉(zhuǎn)移病灶進(jìn)行再次活檢以明確受體表達(dá)情況。
[Abstract]:Background: breast cancer is one of the most common malignant tumors in women. Epidemiological data show that the incidence of breast cancer is increasing year by year. The treatment of advanced metastatic breast cancer is still far from the ideal level, and the median survival time is 2-3 years after treatment with conventional treatment methods such as chemotherapy, radiotherapy, endocrine therapy and targeted therapy. Only a few patients can survive for a long time. At present, the treatment of metastatic breast cancer is mainly based on the different expression of ERP PR and HER-2 receptors on the surface of tumor cells, so as to further select different treatment strategies such as endocrine, chemotherapy, targeting and combined therapy. A number of retrospective studies have reported that there are three different expressions of receptors in the recurrence / metastasis of breast cancer compared with the primary breast cancer, even among different recurrence / metastasis sites in the same breast cancer patients. There is heterogeneity expression of ERP PR and HER-2 receptors between bilateral breast cancer lesions. These phenomena further affect the prognosis and treatment options. Objective: to investigate the different expression of three receptors between recurrent / metastatic lesions and primary lesions of breast cancer in our center. To further investigate the age of the patients, the interval between recurrence and metastasis, and whether the factors such as endocrine, chemotherapy and targeted therapy were not related to the expression of the three receptors. Methods: the expression of ERP PR and HER-2 on tumor cells were analyzed retrospectively in patients with advanced breast cancer from 2013.9 to December 2016 in the hospital affiliated to run Shaw University of Zhejiang University, and the expression of ERPR and HER-2 on the tumor cell surface in the primary tumor, recurrence and distant metastasis specimens were analyzed. The correlation between the age of patients, the interval between recurrence and metastasis, and the factors such as endocrine, chemotherapy and targeted therapy were analyzed retrospectively. Results: the expression of 3 receptors on tumor cells in 96 patients with advanced breast cancer were analyzed. The mean age of 96 patients with advanced breast cancer was 49 years old, 33 years old and 76 years old. All patients with primary breast cancer underwent radical mastectomy or modified radical mastectomy. 96 patients underwent postoperative adjuvant therapy such as radiotherapy. Six patients with endocrine therapy and chemotherapy had been treated with Herceptin targeted therapy. ERP and HER2 were not consistent in primary breast tumor focus and recurrence and metastasis. The inconsistent rates were 200.3434 and 1313 respectively. Age, recurrence / metastasis interval, previous treatment such as endocrine therapy, chemotherapy and targeted therapy were not significantly correlated with the expression of the three receptors. The potential therapeutic regimen adjustment rate due to the inconsistent expression of related receptors in primary breast tumors and metastases is about 23.3%. Conclusion: it is found that the expression of ERPR and HER2 receptors is inconsistent between the primary breast cancer and the recurrence / metastasis in the same breast cancer patients, which may further affect the subsequent treatment of the patients. Therefore, the study concluded that if it is clinically possible, patients with advanced breast cancer should be re-biopsied to determine the expression of receptors.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9
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本文編號(hào)：2042667