摘要目的 分析不同分子分型乳腺癌患者的长期预后,并初步探讨不同治疗方式对其预后的影响.方法 采用以人群为基础的前瞻性队列研究方法.研究对象为上海市肿瘤登记处登记的2002年3月至2006年4月上海市9个区新诊断的、具有上海市户籍的女性乳腺癌患者.共3 586例患者纳入研究,根据雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER2)表达情况分为Luminal A型、Luminal B型、HER2过表达型和三阴性4种.诊断后平均6个月完成基线调查,并在诊断后18、36、60和120个月进行随访调查.通过入户调查、病史摘录和全死因库链接等途径采集信息.采用Kaplan-Meier法分析和比较不同分子分型乳腺癌患者生存率,并运用多因素Cox回归模型探讨不同治疗方式对不同分子分型预后的影响.结果 在3 586例患者中,54.5％为Luminal A型,16.6％为Luminal B型,13.9％为HER2过表达型,14.9％为三阴性.随访时间0.6～12.8年,中位随访时间10.3年.Luminal A型、Luminal B型、HER2过表达型、三阴性乳腺癌患者的10年总体生存率分别为82.7％(95％ CI:80.9％～84.4％)、77.7％ (95％ CI:74.1％～80.8％)、76.3％(95％ CI:72.3％ ～ 79.8％)、74.8％ (95％ CI:70.9％ ～78.3％),10年无病生存率分别为79.0％(95％ CI:76.7％～81.0％)、76.0％ (95％ CI:71.9％ ～79.5％)、73.6％ (95％ CI:68.9％～77.7％)、74.5％(95％ CI:69.4％ ～78.9％).不同分子分型乳腺癌总体生存率和无病生存率间差异均有统计学意义(Log-rank检验,P＜0.01).多因素Cox回归分析结果显示,内分泌治疗可降低Luminal A型乳腺癌长期死亡风险和复发/乳腺癌死亡风险,辅助化疗能改善三阴性乳腺癌长期预后.结论 乳腺癌分子分型对判断患者的预后具有重要临床意义,可为制定乳腺癌个体化治疗提供重要依据.

abstractsObjectives To analyze the survival of breast cancer molecular subtypes and to examine the effect of therapy on the long-term prognosis of different subtypes.Methods This study included 3 586 breast cancer patients with estrogen receptor (ER),progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) information in Shanghai Breast Cancer Survival Study,a population-based prospective cohort study established in 2002.Molecular subtypes,based on immunohistochemistry were categorized as follows:Luminal A,Luminal B,HER2,and triple-negative subtype.Characteristics and clinical data were collected through questionnaires and medical records at baseline survey and sequential follow-up surveys.Survival rates of different molecular subtypes were analyzed and compared with Log-rank tests.Multiple Cox regression models were used to evaluate the effect of therapy on long-term prognosis of different molecular subtypes.Results Among the 3 586 cases,Luminal A,Luminal B,HER2 and triple-negative breast cancer subtypes accounted for 54.5％,16.6％,13.9％,and 14.9％,respectively.With a median follow-up of 10.3 years (ranging 0.6 to 12.8 years),the 10-year overall survival (OS) rates for the four subtypes were 82.7％ (95％ CI:80.9％ to 84.4％),77.7％(95％ CI:74.1％ to80.8％),76.3％ (95％ CI:72.3％ to79.8％),and74.8％ (95％ CI:70.9％ to 78.3％),respectively.The 10-year disease to free survival (DFS) rates were 79.0％ (95％ CI:76.7％ to 81.0％),76.0％ (95％ CI:71.9％ to79.5％),73.6％ (95％ CI:68.9％ to 77.7％),and 74.5％ (95％ CI:69.4％ to 78.9％),respectively.Significant difference in survival among four subtypes was observed (Log-rank test,P ＜ 0.01).Multivariate Cox regression indicated that hormonal therapy can significantly reduce the long-term risk of total mortality and recurrence breast cancer specific mortality among Luminal A subtype patients.Adjuvant chemotherapy could improve the long-term prognosis of triple-negative breast cancer.No benefit from radiotherapy was observed for four subtypes of breast cancer in terms of long-term prognosis.Conclusions Molecular subtypes based on ER/PR/HER2 could provide important information to predict breast cancer prognosis.The hormonal status was an important basis for individualized therapy and precision medicine.