| Background:Breast cancer is one of the female malignancies with high incidence in the world,and ranks the first malignancies among female in China.The morbidity mainly presents two major trends: on the one hand,the morbidity rate increases rapidly year by year,on the one hand,the age of morbidity is younger,which seriously affect the physical and mental health of women now.More and more attention has been paid to the occurrence,development,treatment and prognosis of breast cancer.As people pay more attention to breast cancer,more and more experts and scholars use biological markers in breast cancer tissues to guide the clinical treatment of patients,evaluate the prognosis and the risk of recurrence and metastasis.At present,the trend of breast cancer research at home and abroad is changing from clinical imaging features to molecular genes.There is no denying that clinical research on breast cancer diagnosis and treatment has made great achievements and progress.However,the rate of partial recrudescence and distant metastasis is still very high.The failure of clinical treatment caused by recurrence or metastasis is still an urgent problem to be solved.Molecular bio-markers play an important role in guiding patients to further evaluate the prognosis therapy : estrogen receptor(ER) progesterone receptor(PR) human epidermal growth factor receptor 2(Her-2) nuclear related antigen(Ki-67).The immunohistochemical examination in cancer tissue cells in recurrent metastases to among patients with breast recurrence or metastasis cancer find that immunohistochemical results were different from those in the primary lesions and the differences were statistically significant.Metastasis of breast cancer patients use the immunohistochemical examination again and the result of testing guide the treatment Immunohistochemical examination of cancer cells with simultaneous ipsilateral axillary lymph node metastasis revealed differences between the expression of cancer cells and that of the primary lesions.However,the differences are not uniform.No consensus has been reached on whether simultaneous detection of ipsilateral axillary lymph node metastasis is needed.Purpose:Through the detection of the biological marker ER,PR,Her-2 and Ki-67 for lymph node metastasis in breast cancer patients with concurrent ipsilateral axillary lymph node metastasis,the expression status and differences between the primary and concurrent ipsilateral axillary lymph node metastasis were analyzed and compared to explore the reference value of changes for guiding clinical treatment.Methods:Retrospects and analyzes the period 2016 January to November 2018,He Nan university first affiliated hospital of mammary gland surgical treated except with ipsilateral axillary lymph node metastasis from otHer parts without distant metastases of 53 cases of female breast cancer patients clinical data,compare analysis of ER?PR?Her-2?Ki-67 four markers in breast cancer primary tumors with ipsilateral axillary lymph node metastases from express similarities and differences.The results adopt SPSS Statistics software 24.0,and P < 0.05 is statistically significant.Result:1.The positive expression rates of ER,PR and Her-2 in the primary foci of the 53 patients were 92.5%(49/53),83.0%(44/53),32.1%(17/53),and the high expression rates of Ki-67 were 56.6%(30/53).The positive expression rates of ER,PR and Her-2 in ipsilateral axillary lymph node metastasis were 92.5%(49/53),90.6%(48/53)and 60.4%(32/53),respectively,and the high expression rate of Ki-67 was 45.3%(24/53).The positive expression rate of ER,PR and Her-2 in the primary foci and the negative expression rate of ipsilateral axillary lymph node metastasis in the same period were 3.8%(2/53),1.9%(1/53)and 1.9%(1/53),respectively.The high expression rate of Ki-67 in the primary site and the low expression rate in axillary lymph node metastasis were 13.2%(7/53).Negative expression of ER,PR and Her-2 in the primary site and positive expression in the same period of ipsilateral axillary lymph node metastasis were respectively 1.9%(1/53),9.4%(5/53)and 30.2%(16/53),and 11.3%(6/53)of Ki-67 were low expression in the primary site but high expression in axillary lymph node metastasis.The differences in the expression of ER,PR,Her-2 and Ki-67 were 5.7%(3/53),11.3%(6/53),32.1%(17/53)and 24.5%(13/53),respectively,between the primary lesions and the simultaneous ipsilateral axillary lymph node metastasis.There were statistically significant differences in the expression of ER,Her-2 and Ki-67(P < 0.05)and no statistically significant differences in the expression of PR(P > 0.05).2.Among the 53 patients with changes in biological markers,27.2%(25/53)of the original lesions of the corresponding ipsilateral axillary lymph node metastasis were inconsistent in molecular typing.Tere were 5 patients who changed from Luminal A type to Luminal B(Her-2 positive)type,1 patient who changed from Luminal A type to Luminal B(Her-2 negative)type,2 patients who changed from Luminal B(Her-2 negative)type to Luminal A type,10 patients who changed from Luminal B(Her-2 negative)type to Luminal B(Her-2 positive)type,and 2 patients who changed from Luminal A to Luminal B(Her-2 negative)type.One patient changed from Luminal B(Her-2 positive)to Her-2 overexpression,one patient changed from Luminal B(Her-2 positive)to Luminal A,two patients changed from triple-negative to Luminal B(Her-2 negative),and one patient changed from triple-negative to Her-2 overexpression.3.There was no correlation between age,maximum diameter of tumors,menopause,pathological stage of tumors and the expression of ER,PE,Her-2 and Ki-67 in primary breast cancer and simultaneous ipsilateral axillary lymph node metastasis.(P > 0.05).Their differences have no statistical significance.Number of lymph node metastasis and histological grading and ER,PR,Ki-67 in primary tumors and ipsilateral axillary lymph node metastases in the same period expressed no relevant change,there was no statistically significant difference(P > 0.05),the number of lymph node metastasis and histological grade associated with the change of its Her-2 expression,statistically significant difference(P < 0.05),the results show that in the lymph node metastasis number 3 and 10 or more or less the same period in patients with central plains stove and ipsilateral axillary lymph node metastases,the expression of its Her-2 high consistency between the histological grading of level III of the patients,The Her-2 expression was consistent between the primary lesions and the contemporaneous axillary lymph node metastasis.4.There was no correlation between the expressions of ER,PR,Her-2 and Ki-67 in primary breast cancer and ipsilateral axillary lymph node metastasis.5.There was no correlation between the expression of ER and PR in the primary lesions and the differences of Her-2 and Ki-67 between the primary lesions and the simultaneous ipsilateral axillary lymph node metastasis.6.Logistic regression analysis showed that age,tumor diameter,TNM stage and menopause had no effect on the expression of axillary lymph node metastasis,and histological grade was a protective factor for the increase of ER and PR expression rates in axillary lymph node metastasis in the same period,with statistically significant significance.Conclusion:ER?PR?Her-2?Ki-67 have differences in expression between the primary lesions and the simultaneous ipsilateral axillary lymph node metastasis.And the differences between ER,Her-2 and Ki-67 is statistically significant.The number of lymph node metastasis and histological differentiation of patients have an effect on the expression of Her-2,but no effect on the expression of ER,PR and Ki-67.Histological grade is a protective factor for increased ER and PR expression in axillary lymph node metastasis.The expression changes of the above four biological markers in the primary site and the simultaneous ipsilateral axillary lymph node metastasis primary lead to inconsistent molecular typing.In the process of clinical treatment,comprehensive pathological examination is recommended to increase the probability of treatment benefit for some patients.Long-term follow-up is needed to confirm the therapeutic benefits of the changes in expression between the primary lesion and the simultaneous ipsilateral axillary lymph node metastasis. |
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