The Analysis Of Expression Of Protein ER,PR And Her2 To The Prognosis Of Breast Cancer

Breast cancer is one of the commonest malignant tumors in women.There were 1,200,000 women diagnosed of breast cancer and nearly 500,000 died of it each year.Also,there is an obvious increasing trend about 0.2%—8% in morbility in our country this century.Particularly in some big cities,the number of the dead caused by breast cancer has occupied the first of the feminine malignant tumor.Metastasis and recurrence of breast cancer are the common reason of death. So the key to reduce breast cancer mortality is to seek factors correlated with metastasis and recurrence,and take corresponding treatment. With the quick advancement of on comole cularbiology, we realize that tumorigenesis progression of malignant tumor is a complex process involving polygene regulation,including activation of proto-oncogene,abnormalities of suppressor gene,metalloproteinases expression disorders with their inhibitors and a series of molecular disorders incident. So breast cancer prognosis indicators also become more diversified.Among the total,Her2,PR and ER are particularly important on the incidence,development,treatment options and prognosis of breast cancer.In order to further clarify the relevance and clinical characteristic of them,we analyzed 62 patients from August 1998 to January 2002 retrospectively, studying the relationship between each one with clinical characters which contain age,tumor size,pathology type,menstrual status,TNM stage,axillary lymph node metastasis,distant metastasis,live time and the relevance of themselves.We took 115 cases of breast cancer patients aged 24-80 years with anaverage age of 41 years. The results showed that patients with ER positive were 27 cases,with the positive rate of 43.55%(27/62);24 cases were Her2 positive expression, with the positive rate of 38.71%(24/60),36 cases of PR positive expression accounted 58.06%(36/62)of all.The expression of PR was negatively associated with Her2 with correlation coefficient-0.533(P<0.01),and positively with ER,the correlation coefficient is-0.297(P<0.05),while the expression of Her2 was negatively associated with ER,the correlation coefficient is 0.285(P<0.05).ER positive rate of patients with TNM stageⅠ,Ⅱ,Ⅲ,Ⅳwas 68.75%,37.03%,35.71%,20.00%(P<0.05)respectively.ER positive rate of patients whose survival time were more than five years was 56.25%,which is higher than the rate of 21.05%(P<0.05)which belong to whose survival time less than five years.Her2 positive rate of 24-35,36-55, 56-80 years of age group was 72.73%,34.15%and 20.00%(P<0.05) respectively.Among patients whose tumor diameter longer than 5.0 cm,2.0 to 5.0cm and shorter than 2.0 cm groups,Her2 positive rate was 24.24%,52.17%and 66.67%(P<0.05)respectively.In patients with TNM stageⅠ,Ⅱ,ⅢandⅣ,Her2-positive rate was respectively 12.50%,40.74%,57.14% and 60.00%(P<0.05). PR positive rate of 36-55,56-80 age group was 69.69%,52.17%,16.67%(P<0.05) respectively.Positive rate of TNM classificationⅠwas 87.5%,higher than that of stageⅡ,ⅢandⅣ:62.96%,28.57%and 20.00%(P<0.05).PR positive rate of patients with axillary node-negative,no distant metastasis,survival more than five years were 75.00%,85.71%,75.00%,which were significantly higher than that of patients with axillary lymph nodes,distant metastasis,survival time less than five years: 44.12%, 35.29%, 42.11% (P<0.05). Kaplan-Meier method showed better overall survival time in patients with PR or ER positive expression than those without(P<0.05),and Her2 negative expression exhibited a significantly better prognosis than Her2 positive expression(P<0.05).In multivariate Cox regression analysis,the expression of Her2,and TNM stage were two important prognostic factors of breast carcinoma.The hazard ratios of Her2 expression and TNM stage was 4.918(P<0.01)and 4.452 respectively(P<0.05).To sum up,The expression of PR was negatively associated with Her2,and positively with ER,while the expression of Her2 was negatively associated with ER.Univariate analysis showed that ER positive patients were usually corresponding with early TNM stage,high survival advantage;Her2 positive ones were young,premenopause,with large tumor, late TNM stage,axillary lymph nodes and distant metastasis,short survival time;PR positive ones were usually corresponding with small tumor,early TNM stage,no axillary lymph nodes and distant metastases,long survival time.Multivariate analysis showed that Her2 and TNM stage were two independent adverse prognostic indicators in breast cancer.