廣西家族性乳腺癌臨床病理特征的相關(guān)研究
發(fā)布時(shí)間：2018-07-14 16:03
【摘要】：目的：通過回顧性分析家族性乳腺癌和散發(fā)性乳腺癌的女性患者的臨床病理相關(guān)指標(biāo),旨在探究家族性乳腺癌和散發(fā)性乳腺癌患者的臨床病理特征,揭示家族性乳腺癌獨(dú)特的臨床病理學(xué)及分子生物學(xué)特性,為今后指導(dǎo)女性乳腺癌患者的臨床個(gè)體化治療提供理論依據(jù),為進(jìn)一步研究家族性乳腺癌的遺傳易感因素提供參考。方法：收集2013年6月至2015年3月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院胃腸腺體外科住院并行手術(shù)治療且術(shù)后病理證實(shí)為乳腺癌的患者722例。通過電話調(diào)查、患者返院復(fù)查、翻閱病歷記錄或檔案的方式進(jìn)行隨訪。按照家族中一級(jí)、二級(jí)親屬中有1例或以上為乳腺癌患者,將其劃為家族性乳腺癌,反之為散發(fā)性乳腺癌。根據(jù)所制定的病例納入標(biāo)準(zhǔn)及剔除標(biāo)準(zhǔn),最后篩選出符合要求的乳腺癌家族史陽性患者43例,無乳腺癌家族史的患者402例。將兩組患者的臨床病理指標(biāo)、復(fù)發(fā)、轉(zhuǎn)移等情況采用x2檢驗(yàn)行單因素分析,從臨床病理特征、分子生物學(xué)行為等方面對(duì)家族性乳腺癌與非家族性乳腺癌患者進(jìn)行分析比較。結(jié)果：家族性乳腺癌患者占同期乳腺癌患者的5.9%。家族性乳腺癌患者在組織學(xué)分級(jí)III級(jí)所占的比例(37.2%)明顯高過散發(fā)性乳腺癌的患者(22.6%),且兩組間有統(tǒng)計(jì)學(xué)差異(x2=4.517,P=0.034)；家族性乳腺癌患者的ER表達(dá)陰性率(39.5%)高于散發(fā)性乳腺癌患者(25.4%),兩組間差異有統(tǒng)計(jì)學(xué)意義(x2=3.977,P=0.046)；但兩組患者在年齡分布(x2=0.149,P=0.928)、民族(χ2=0.167,P=0.683).BMI (χ2=3.075, P=0.380)、絕經(jīng)狀態(tài)(x2=0.722,P=0.396)、腫瘤大小(x2=3.864,P=0.145)、病理類型(x2=2.917,P=0.176)、臨床分期(x2=1.267,P=0.531)、腋窩淋巴結(jié)轉(zhuǎn)移率(x2=0.734,P=0.392)等方面均無統(tǒng)計(jì)學(xué)意義；在PR(χ2=0.142,P=0.706)、 HER-2(χ2=2.053,P=0.358)、Ki-67 (χ2=0.070,P=0.791)表達(dá)上及乳腺癌分子分型(x2=1.129,P=0.770)方面差異也無統(tǒng)計(jì)學(xué)意義；而有家族史的乳腺癌患者在術(shù)后試探性的短期隨訪時(shí)間內(nèi)發(fā)生復(fù)發(fā)、轉(zhuǎn)移、死亡的總比例(14.0%)高于無家族史的乳腺癌患者(4.5%),兩組間差異有統(tǒng)計(jì)學(xué)意義(x2=5.105,P=0.024)。結(jié)論：1、廣西地區(qū)家族性乳腺癌的發(fā)生率低于國外和國內(nèi)某些地區(qū),與散發(fā)性乳腺癌比較在一些臨床病理特征上有差異,具體還需結(jié)合基因等相關(guān)因素進(jìn)一步探究。2、本地區(qū)家族性乳腺癌患者的組織學(xué)分級(jí)III級(jí)所占的比例高,且有統(tǒng)計(jì)學(xué)差異,提示家族史因素可能與腫瘤的組織分化差、惡性程度高、預(yù)后不良相關(guān),有待深入研究。3、本地區(qū)家族性乳腺癌ER陰性表達(dá)率高于散發(fā)性乳腺癌,預(yù)示家族性乳腺癌分子生物學(xué)行為差,對(duì)內(nèi)分泌治療不敏感,需采取更為積極的系統(tǒng)性治療。4、家族性乳腺癌可能預(yù)后更差,這還需我們今后繼續(xù)尋找有價(jià)值的臨床病理指標(biāo),針對(duì)指標(biāo)對(duì)不同患者進(jìn)行個(gè)體化治療。
[Abstract]:Objective: to investigate the clinicopathological features of familial breast cancer and sporadic breast cancer by retrospectively analyzing the clinicopathological features of familial breast cancer and sporadic breast cancer. To reveal the unique clinicopathological and molecular biological characteristics of familial breast cancer, to provide theoretical basis for guiding clinical individualized treatment of female breast cancer patients in the future, and to provide a reference for further study of genetic susceptibility factors of familial breast cancer. Methods: from June 2013 to March 2015, 722 patients with breast cancer were admitted to the first affiliated Hospital of Guangxi Medical University for surgical treatment and proved to be breast cancer by pathology. The patients were followed up by telephone survey, re-examination and review of medical records or files. According to the first degree in the family, one or more of the second-degree relatives were classified as familial breast cancer and sporadic breast cancer. According to the criteria of inclusion and exclusion of breast cancer, 43 patients with positive family history of breast cancer and 402 patients with no family history of breast cancer were selected. The clinicopathological parameters, recurrence and metastasis of the two groups were analyzed and compared between familial breast cancer and non-familial breast cancer in terms of clinicopathological characteristics and molecular biological behavior by using x2 test. Results: familial breast cancer patients accounted for 5.9% of breast cancer patients in the same period. The proportion of familial breast cancer patients in histological grade III (37.2%) was significantly higher than that in sporadic breast cancer patients (22.6%). The negative rate of ER expression in familial breast cancer patients (39.5%) was significantly higher than that in sporadic breast cancer patients (25.4%). However, there was no significant difference in age distribution (x20.149P0. 928), nationality (蠂 20.167 P0. 683), BMI (蠂 2 + 3. 075, P = 0. 380), menopausal status (x 2 + 0. 722), tumor size (x 23. 864P0. 145), pathological type (x 2 = 2. 917), clinical stage (x 2 + 1. 267 P 0. 531), axillary lymph node metastasis rate (x 20.734 P 0. 392) between the two groups. There was no significant difference in the expression of PR (蠂 ~ 2 + 0.142), HER-2 (蠂 ~ (2 +) 2.053) ~ (0.358) and Ki-67 (蠂 ~ (2 +) ~ (0.070) P _ (0.791) and the molecular classification of breast cancer (x _ (2) 1.129) (P _ (0.770), but there was no significant difference in the expression of Ki-67 and the molecular type of breast cancer (x _ (2) 1.129) (P _ (0.770), while the recurrence and metastasis of breast cancer patients with a family history were observed during the tentative follow-up period after operation. The total mortality rate (14.0%) was higher than that in breast cancer patients without family history (4.5%), and the difference between the two groups was statistically significant (x2 + 5.105%, P < 0.024). Conclusion the incidence of familial breast cancer in Guangxi is lower than that in some foreign and domestic areas, and there are differences in some clinicopathological features between Guangxi and sporadic breast cancer. The proportion of histological grade III in familial breast cancer patients in this area is high, and there is statistical difference, which suggests that family history factors may be poor in differentiation with tumor tissue. The negative expression rate of ER in familial breast cancer is higher than that in sporadic breast cancer, which indicates that the molecular biological behavior of familial breast cancer is poor, and it is insensitive to endocrine therapy. It is necessary to take more active systemic therapy. 4. The prognosis of familial breast cancer may be worse. It is also necessary for us to continue to search for valuable clinicopathological indicators and individualized treatment for different patients.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.9
[Abstract]:Objective: to investigate the clinicopathological features of familial breast cancer and sporadic breast cancer by retrospectively analyzing the clinicopathological features of familial breast cancer and sporadic breast cancer. To reveal the unique clinicopathological and molecular biological characteristics of familial breast cancer, to provide theoretical basis for guiding clinical individualized treatment of female breast cancer patients in the future, and to provide a reference for further study of genetic susceptibility factors of familial breast cancer. Methods: from June 2013 to March 2015, 722 patients with breast cancer were admitted to the first affiliated Hospital of Guangxi Medical University for surgical treatment and proved to be breast cancer by pathology. The patients were followed up by telephone survey, re-examination and review of medical records or files. According to the first degree in the family, one or more of the second-degree relatives were classified as familial breast cancer and sporadic breast cancer. According to the criteria of inclusion and exclusion of breast cancer, 43 patients with positive family history of breast cancer and 402 patients with no family history of breast cancer were selected. The clinicopathological parameters, recurrence and metastasis of the two groups were analyzed and compared between familial breast cancer and non-familial breast cancer in terms of clinicopathological characteristics and molecular biological behavior by using x2 test. Results: familial breast cancer patients accounted for 5.9% of breast cancer patients in the same period. The proportion of familial breast cancer patients in histological grade III (37.2%) was significantly higher than that in sporadic breast cancer patients (22.6%). The negative rate of ER expression in familial breast cancer patients (39.5%) was significantly higher than that in sporadic breast cancer patients (25.4%). However, there was no significant difference in age distribution (x20.149P0. 928), nationality (蠂 20.167 P0. 683), BMI (蠂 2 + 3. 075, P = 0. 380), menopausal status (x 2 + 0. 722), tumor size (x 23. 864P0. 145), pathological type (x 2 = 2. 917), clinical stage (x 2 + 1. 267 P 0. 531), axillary lymph node metastasis rate (x 20.734 P 0. 392) between the two groups. There was no significant difference in the expression of PR (蠂 ~ 2 + 0.142), HER-2 (蠂 ~ (2 +) 2.053) ~ (0.358) and Ki-67 (蠂 ~ (2 +) ~ (0.070) P _ (0.791) and the molecular classification of breast cancer (x _ (2) 1.129) (P _ (0.770), but there was no significant difference in the expression of Ki-67 and the molecular type of breast cancer (x _ (2) 1.129) (P _ (0.770), while the recurrence and metastasis of breast cancer patients with a family history were observed during the tentative follow-up period after operation. The total mortality rate (14.0%) was higher than that in breast cancer patients without family history (4.5%), and the difference between the two groups was statistically significant (x2 + 5.105%, P < 0.024). Conclusion the incidence of familial breast cancer in Guangxi is lower than that in some foreign and domestic areas, and there are differences in some clinicopathological features between Guangxi and sporadic breast cancer. The proportion of histological grade III in familial breast cancer patients in this area is high, and there is statistical difference, which suggests that family history factors may be poor in differentiation with tumor tissue. The negative expression rate of ER in familial breast cancer is higher than that in sporadic breast cancer, which indicates that the molecular biological behavior of familial breast cancer is poor, and it is insensitive to endocrine therapy. It is necessary to take more active systemic therapy. 4. The prognosis of familial breast cancer may be worse. It is also necessary for us to continue to search for valuable clinicopathological indicators and individualized treatment for different patients.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.9
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