| Objective: To analysis the clinicopathological features and treatments of patients with advanced Luminal B-like breast cancer,and to explore the prognostic factors of them.Methods: We retrospectively analyzed the clinical and pathological features of 206 patients with advanced Luminal B-like breast cancer treated in our hospital between June 2008 and June 2013.According to the expression of human epidermal growth factor receptor-2(HER-2),patients were divided into HER-2 positive type and HER-2 negative type group.To analyze the clinicopathological features of 206 patients with advanced Luminal B-like breast cancer,and to compare the clinicopathological features of HER-2 positive and HER-2 negative patients and to explore the prognostic factors of advanced Luminal B-like breast cancer.The statistical analysis was performed using statistical software SPSS 22.0.The data between two groups were analyzed by χ2 test.Kaplan-Meier method was used to analyze the survival of the patients.Univariate analysis was performed using Log rank test,and Cox regression model was used for multivariate analysis.P<0.05 was statistically significant.Results: Among 206 patients with advanced Luminal B-like breast cancer,188 cases received local treatment(radical mastectomy or modified radical surgery)after diagnosis of breast cancer,except for patients with stage Ⅳ.The median age at diagnosis with breast cancer in 206 cases was 46(23 ~ 73)years.Patients with invasive ductal carcinoma accounted for 90.3%(186/206).The proportion of primary tumor size of T1,T2,T3,T4 and unknown stage was 24.8%(51/206),53.9%(111/206),9.2%(19/206),4.9%(10/206)and 7.3%(15/206),T2 were mostly;The percentage of patients with axillary lymph node metastasis with N0,N1,N2 and N3 was 27.7%(57/206),29.1%(60/206),18.9%(39/206)and 24.3%(50/206);The proportion of patients with gradeⅠ,Ⅱand Ⅲwas 1.9%(4/206),85.0%(175/206)and 13.1%(27/206),respectively grade Ⅱ;The proportion of patients with Ki-67index<14%,from 14% to 30% and >14% was 4.4%(9/206),39.3%(81/206)and56.3%(116/206),Ki-67 index>30% was the most;Most patients had disease-free survival less than 36 months,accounting for 68.9%(142/206),disease-free survival of patients≥36 months accounted for 31.1%(64/206).Among 206 cases,human epidermal growth factor receptor 2(HER2)positive subtype was found in 54 cases(26.2%)and negative in 152 cases(73.8%).There were no significant differences in age,pathological type,tumor size,lymph node metastasis,clinical stage,histological grade and hormone receptor status between different subtypes.The proportion of Ki-67>30% in HER-2 positive subtype 57.4%(31/54)was significantly higher than that in HER-2 negative subtype 55.9%(85 /152)(P < 0.01).The percentag of disease-free survival < 36 months in HER-2 positive subtype 79.6%(43/54)was dramatically higher than that of HER-2 negative subtype65.1%(99/152)(P<0.05).The median age of recurrence was 49(26~77)years old and the median DFS was 23(0 ~ 90)months.When first diagnosed with recurrence and metastasis,solitary metastatic sites accounted for 42.7%(88/206),multiple accounted for 57.3%(118/206),which accounted for 67.5% of visceral involvement(139/206),47.1%(97/206)of bone metastases.After metastasis,98.5%(203/206)of patients received chemotherapy,57.8%(119/206)of patients underwent endocrine therapy,and 14.6%(30/206)received radiotherapy.Among patients receiving chemotherapy,effective for the first-line chemotherapy CR、PR was 9.8%(20/203),41.4%(84/203),stable disease(SD)in 36.5%(74/203),disease progression(PD)in 12.3%(25/203).There was no significant difference in the age of metastasis,the number of first metastasis,visceral metastasis and bone metastasis in patients with different subtypes.Among the patients treated with chemotherapy,the evaluation of curative effect of HER-2positive first-line rescue chemotherapy CR,PR accounted for 14.8%(8/54),40.7%(22/54),SD accounted for 38.9%(21/54),PD accounted for 5.6%(3/54),the DCR was 94.4%(51/54),the evaluation of curative effect of HER-2 negative first-line rescue chemotherapy CR,PR accounted for 8.1%(12/149),41.6%(62/149),SD accounted for 35.5%(53/149),PD accounted for 14.8%(22/149),the DCR was85.2%(127/149),the disease control rate of HER-2 positive first-line chemotherapy was better than that of HER-2 negative type,but the difference was not statistically significant.The median metastases-overall survival was 25(2.1~85.0)months.We found that tumor size,visceral metastases,the number of first metastatic sites,first-line chemotherapeutic effect and palliative endocrine therapy are associated with the prognosis of advanced Luminal B-like breast cancer(P<0.05).Multivariate analysis revealed that visceral metastases,first-line salvage chemotherapeutic effect and palliative endocrine therapy were the independent predictors of survival in advanced Luminal B-like breast cancer(P < 0.05).The median M-OS was 37.4 months in patients without visceral metastasis,and it was significantly better than that in patients with visceral metastases whose median M-OS was 33.4 months(P<0.05).The median M-OS was 36.0,31.0,22.0 and 18.0 months for the evaluation of the efficacy of first-line chemotherapy in patients with CR,PR,SD and PD,the median M-OS of patients with CR,PR and SD was significantly better than that of PD(P<0.05).The median M-OS was 38.6 months in the patients who recevied endocrine therapy,and it was significantly better than those who did not receive endocrine therapy(21.7 months)(P<0.05).Conclusions: Among advanced Luminal B-like breast cancer patients,the proportion of HER-2 positive type was lower than that of HER-2 negative type,but HER-2positive type was more commonly diagnosed with higher Ki67 index,quicker and easier recurrence and metastasis within three years than HER-2 negative type.The median metastases-overall survival of patients with advanced Luminal B-like breast cancer was 25 months.Visceral metastases,poor effect of f irst-line salvage chemotherapy and not receiving palliative endocrine therapy were independent factors of poor prognosis for the survival of advanced Luminal B-like breast cancer. |
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