| Objective To investigate the clinicopathological features and prognostic significance of HER2 expression in invasive papillary carcinoma of the breast(IMPC).Methods Data of 102 IMPC cases within the period from July 2010 to July 2013 treated in the Tumor Hospital of Liaoning Province were retrospectively analyzed.The median follow-up was 45 months.The clinical features,pathological characteristic and prognosis factors of IMPC were analyzed.Meanwhile,102 cases of invasive ductal carcinoma(IDC)of the breast in the same period were randomly selected as control group.Survival prognostic indicators were compared between the two groups.To investigate the effect of HER2 expression on the survival prognosis of IMPC,the immunohistochemistry(IHC)and the fluorescence in situ hybridization(FISH)were used to detect the expression and gene amplification of HER2 respectively about the patients of IMPC,and analyzed the survival prognostic indicators between the two groups in different HER2 expression.In addition,the TOP2 A gene was detected by FISH in the group of HER2 overexpression or gene amplification and the prognostic factors of survival between the two groups were analyzed.Using Kaplan-Meier for the survival analysis,its Log Rank test was used to compare survival and analyze univariate survival.The multivariate Cox proportional hazard model was used to analyze the factors affecting post-treatment survival.Results In 102 cases of IMPC,the median age was 54 years and the tumor size ranged from 0.8 to 6.5cm.68 cases(66.7%)showed vascular invasion,Lymph node metastasis was found in 58 cases(56.9%),and the number of lymph node metastasis was 4 or above in 36 cases(62.1%).The positive rates of ER,PR,HER2 and Topo II? of the IMPC cases respectively were 79.4%(81/102),36.3%(74/102),(37/102)and 60.1%(62/102).The positive rate of Ki67 and 14% above in IMPC was 68.6%(70/102).In the over expression or gene amplification of HER2,62.2%(23/37)TOP2A gene showed amplification.Survival analyzed by Kaplan-Meier.The survival prognostic indicators of IMPC group and IDC group as followed,the local recurrence free survival rate(LRFS)of IMPC group and IDC group were 91.2%(93/102),99%(101/102)respectively.And the metastasis free survival rate(MFS)of IMPC group and IDC group were 80.4%(82/102),97.1%(99/102)respectively.The overall survival(OS)of IMPC group and IDC group were 94.1%(96/102),96.1%(98/102)respectively.So the LRFS and MFS in the IMPC group was lower than that of IDC group(P=0.007 and P<0.001),but there was no significant difference in OS between the two groups(P=0.391).Comparing two groups of survival analysis expression of different HER2 in IMPC breast,we found that the local recurrence free survival rate of them were 83.8% and 95.4% respectively and There was statistical significance between the two groups(P=0.044).There was also statistical significance in the two groups(P<0.001)about the metastasis free survival rate.They were 59.5% and 92.3%.Besides,the overall survival rate had the same result and they respectively were 86.5% and 98.5%.Therefore,in the overexpression or gene ampli-fication of HER2 in IMPC patients was lower than those in LRFS,MFS and OS,which were the weak expression of HER2.The differences were statistically significant(P<0.05).There were two groups in HER2 overexpression or gene amplification,TOP2 A gene amplified and not amplified.The survival analysis of two groups respectively were similar,LRFS(95.7% vs.64.3%,P=0.012),MFS(87.0% vs.14.3%,P<0.001)and OS(95.7% vs.71.4%,P=0.042).The results showed that the prognosis of TOP2 A gene amplification was better than no amplification,and the difference was statistically significant(P<0.05).Using Kaplan-Meier univariate survival analysis,the local recurrence free survival(LRFS)of IMPC was associated with lymph node metastasis(P<0.001),TNM stage(P=0.001),HER2 expression(P=0.044)and vascular invasion(P=0.032).And metastasis free survival(MFS)of IMPC was associated with age(P=0.013),lymph node metastasis(P=0.001),TNM stage(P=0.012),HER2 experssion(P<0.001)and neoadjuvant therapy(P=0.003).But the overall survival of IMPC was only correlated with the expression of HER2(P=0.015).Multivariate Cox proportional hazards regression model was used for multivariate survival analysis.The results showed that the HER2 expression,lymph node metastasis and TNM stage are the influence factors of the distant metastasis of IMPC(P=0.013,P=0.028 and P=0.004).However,only the HER2 expression was an independent factor affecting the overall survival of IMPC(P=0.049).Other factors were not independent prognostic factors for survival time of IMPC,such as age,tumor size,histological grade,ER,PR,Ki67,vascular invasion and neoadjuvant(P> 0.05).Conclusion IMPC,which is with high lymph node metastasis rate,high local recurrence rate and distant metastasis,is a special type of breast cancer.The accurate expression of HER2 and TOP2 A has an important effect on its treatment and prognosis. |
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