| Backgrounds: The incidence of breast cancer is rising, currently,which has become the most common malignant tumor in women. The incidence of breast cancer is still rising with the annual growth rate is about 3%to 4%[1], in China,and the age at diagnosis is becoming younger and younger.Although the mortality rate of breast cancer has been greatly reduced by systemic treatment, it is still the second leading cause of death in malignant tumors[2]. Conventional diagnosis of breast cancer only relied on the microscopic findings,and not be further broken down.The treatment method was substantially similar.With the rapid development of molecular biology in the m RNA levels of gene expression analysis[3-5],breast cancer can be classified into four intrinsic subtypes by gene expression profiling:Luminal A,Luminal B,basal-like and HER-2-positive[6]. The St Gallen International Breast Cancer Conference determined a new molecular classification criteria in the genetic level,in 2013,divided breast cancer into four subtypes:1.Luminal A breast cancer:ER(+)and PR overexpression,HER-2(-),Ki-67 lowexpression.2. Luminal B breast cancer:(1) HER-2- negative: ER(+)and HER-2(-),and meet at least one of the following: ?1 Ki-67 overexpression, ?2 HER-2(-)or lowexpression, ?3 Gene expression analysis showed a high risk of recurrence.(2) HER-2- positive: ER(+)and HER-2(+),Ki-67 and PR at any level.3.Triple negative breast cancer: ER(-),PR(-)and HER-2(-).4.HER-2-positive breast cancer: ER(-),PR(-)and HER-2(+).This subtyping method is a good solution to explain the heterogeneity of the tumor,and also provided an important basis for diagnosis and individual treatment of breast cancer.Luminal B breast cancer has the clinical features of aggressive and poor prognosis due to the characteristics of negative or low expression of PR, HER-2 positive and Ki-67 high expression[7].Objective: The purpose of this study was to research the biological characteristics and survival analysis of 211 cases of Luminal B like breast cancer in different molecular subtypes. Study on the effect of PR expression on biological characteristics and prognosis of Luminal B like breast cancer.Aim to provide some reference value in the future clinical understanding and individual treatment of luminal B like breast cancer.Material and Method:(1)The test object: 243 cases of primary breast cancer patients with clinical follow-up data was collected in Department of General Surgery, Shanghai Jiaotong University Affilited to Sixth People's Hospital during January 2006 to January 2010. These patients had underwent operation treatment( modified radical mastectomy, radical resection or breast-conserving surgery),in which 32 were deleted due to lack of clinical data and finally 211 patients were enrolled into our study.(2)The judgment standard: All biopsys were reviewed.Selected 10 randomly high-power field,and then counted the number of positive cells perfield and averaged.Pathological staging and tumor grade and stage were according to the seventh edition of AJCC Cancer Staging Manual,while Molecular subtypes judgment was according to the consensus of the 13 th St.Gallen International Breast Cancer Conference.Menopause standard was based on the 2014 version of the NCCN judgment.(3)Statistical Analysis: All statistical analysis were performed using the SPSS version 17.0 statistical package.Pearson 's X2 test was used to evaluated the significance of differences between designated groups.Using Kaplan-Meier method for survival analysis.p is 0.05 as the size of test.Results: 1. Comparison Clinical Pathology Characteristics of Different Subtypes of Luminal B Breast CancerThis research collected 211 cases of Luminal B like breast cancer patients,in the group A(ER+?PR+?HER-2-?Ki-67 overexpression) were 87(41.2%);group B(ER+?PR-?HER-2-?Ki-67 any level) were 76(36.0%);group C(ER+?HER-2-?PR and Ki-67 any level) were 48(22.8%).There were no statistically significant differences among different molecular subtypes in age(p=0.116)?tumor size(p=0.570)?lymph node status(p=0.406) and clinical staging(p=0.813).The result shows that the Luminal B like breast cancer in different molecular subtypes have no significant difference in clinical and pathological characteristics.2. Univariate Analysis of Different Subtypes of Luminal B like Breast CancerUnivariate analysis showed that age(group A p=0.349; group B p=0.620; group C p=0.584)?histological grade(group A p=0.482; group B p=0.794; group C p=0.557) and the size of the tumor(group A p=0.145; group B p=0.339; group C p=0.587) were not important prognostic factors of Luminal B like breast cancer.However, lymph node metastasis(group A p=0.016; group B p=0.023; group C p=0.047) was prognostic factor. The more lymph node metastasis, the prognosis is poorer.3. Survival Analysis of the Three SubtypesThe survival analysis of different subtypes of breast cancer showed that there were no significant differences among group A?group B?and group C in both DFS rate and OS rate(5years).4. Comparison Clinical Pathology Characteristics of Luminal B like/PR-postive and Luminal B like/PR-negative Breast CancerThere were no significant differences among Luminal B like/PR-postive and Luminal B like/PR-negative Breast Cancer in age(p=0.168)?tumor size(p=0.187)?lymph node status(p=0.336) and clinical staging(p=0.271).The result shows that Luminal B like/PR-postive and Luminal B like/PR-negative breast cancer have no significant difference in clinical and pathological characteristics.5. Survival Analysis of Luminal B like/PR-postive and Luminal B like/PR-negative Breast CancerThe survival analysis of Luminal Blike/PR-postive and Luminal B like/PR-negative breast cancer showed that there was significant difference in DFS rate(5years),but not in OS rate(5years).Conclusion:There are no statistically significant differences in pathological features among the different subtypes of Luminal B like breast cancer. Survival analysis showed that the DFS rate(5years) of Luminal B like/PR-postive breast cancer is better than Luminal B like/PR-negative breast cancer. |
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