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目的探讨雌激素受体(ER)+/孕激素受体(PR)-和 ER+/PR+的两种类型乳腺癌患者肿瘤生物学特性的差异。方法回顾性研究3124例 ER+/PR-或 ER+/PR+的乳腺癌患者,比较其临床病理及免疫组化法测定的分子生物学指标。结果 ER+/PR+和 ER+/PR-的乳腺癌患者的年龄峰值均为50岁,显著高于 ER-/PR-患者的年龄峰值48岁(P<0.05)。且 ER+/PR-的乳腺癌较 ER+/PR+者肿瘤直径大,淋巴结转移个数多、组织学分级低,ER 表达水平低,c-erbB-2呈高表达(P<0.05),而 Cathepsin D 则呈现低表达(P<0.05);但两组间平均年龄差异无统计学意义(P>0.05)。多因素分析显示影响两者不同表型的因子有:肿瘤 ER 表达水平(OR=1.792,95%CI=1.484～2.164,P=0.000)、Cathepsin D 状态(OR=1.380,95%CI=1.023～1.862,P=0.035)及 c-erbB-2表达状态(OR=0.639,95%CI=0.463～0.883,P=0.007)。结论 ER+/PR+与 ER+/PR-的乳腺癌可能有相同的起病原因,但 ER+状态下 PR 表达与否可能有多方面的因素,导致二者的生物学行为不同,针对这些差异寻找新的治疗靶向可能更有助于改善 ER+/PR-患者的内分泌治疗效果及预后。
Objective To investigate the difference of tumor biological characteristics between two types of breast cancer patients with estrogen receptor (ER) / progesterone receptor (PR) - and ER + / PR +. Methods A retrospective study of 3,124 breast cancer patients with ER + / PR- or ER + / PR + was performed. The clinical and pathological features of the breast cancer were compared with those of the immunohistochemical method. Results The average age of breast cancer patients with ER + / PR + and ER + / PR- was 50 years, significantly higher than that of ER- / PR- patients aged 48 years (P <0.05). The ER + / PR-positive breast cancer had larger diameter, more lymph node metastasis, lower histological grade, lower ER expression and higher c-erbB-2 expression (P <0.05) than those with ER + / PR- (P <0.05), but there was no significant difference between the two groups in average age (P> 0.05). Multivariate analysis showed that the factors influencing the phenotypes of the two were: the expression of ER (1.792, 95% CI = 1.484-2.164, P = 0.000), Cathepsin D (OR = 1.380, 95% CI 1.023 ~ 1.862, P = 0.035) and c-erbB-2 expression (OR = 0.639, 95% CI = 0.463-0.883, P = 0.007). Conclusions Breast cancer of ER + / PR + and ER + / PR- may have the same pathogenesis, but there may be many factors that affect the expression of PR in ER + PR, which leads to different biological behaviors. Treatment targeting may be more helpful to improve endocrine therapy outcomes and prognosis in ER + / PR- patients.