目的：探讨乳腺浸润性导管癌不同分子亚型与其腋窝淋巴结转移的关系。方法：根据乳腺癌分子分型标准，将243例原发乳腺浸润性导管癌的手术患者分为Luminal A型、Luminal B型[又分为HER-2（-）和HER-2（+）]、HER-2过表达型和三阴型。结合临床病理资料，分析各分子亚型的分布特点，以及与腋窝淋巴结转移的关系。结果：243例患者中，Luminal B [HER-2（-）]型最多（78例，32.1%），其次是Luminal A型（58例，23.87%），随后为三阴型（41例，16.87%）、HER-2过表达型（34例，13.99%）、Luminal B [HER-2（+）]型（32例，13.17%）；94例（38.68%）发生腋窝淋巴结转移，各分子亚型患者腋窝淋巴结转移发生率差异有统计学意义（P<0.05），其中Luminal B [HER-2（-）]型（42例，53.85%）和Luminal B [HER-2（+）]型（15例，46.88%）中发生率最高，且两者间差异无统计学意义（P>0.05），其后依次为Luminal A型（19例，32.76%），三阴型（12例，29.27%），HER-2过表达型（6例，17.65%）；各分子亚型分布在累及1~3枚及≥４枚淋巴结转移的分组中，差异均无统计学意义（均P>0.05），但前者Luminal B [HER-2（+）]型最多，HER-2过表达型最少，而后者HER-2过表达型最多，Luminal B [HER-2（+）]型最少。结论：乳腺浸润性导管癌的分子分型对评估腋窝淋巴结转移状况、判断疾病状态有一定参考价值，可成为制定个体化诊治策略的依据。
Relationship between molecular subtypes of breast invasive ductal carcinoma and axillary lymph node metastasis
Objective: To investigate the relationship between different molecular subtypes of breast invasive ductal carcinoma (IDC) and axillary lymph node metastasis. Methods: According to the molecular classification criteria of breast cancer, the 243 patients with primary breast IDC undergoing surgical treatment were divided into luminal A, luminal B [further subdivided into HER-2 (–) and HER-2 (+)], HER-2 over expression and triple-negative type. Combining with the clinical pathological data, the distribution characteristics of various molecular subtypes, and the relations of different molecular subtypes with axillary lymph node metastasis were analyzed. Results: Among the 243 patients, cases with Luminal B [HER-2 (–)] type accounted for the majority (78 cases, 32.1%), and Luminal A type was the next (58 cases, 23.87%), followed by triple-negative (41 cases, 16.87%), HER-2 over expression (34 cases, 13.99%) and Luminal B [HER-2(+)] type (32 cases, 13.17%), successively. Axillary lymph node metastasis occurred in 94 cases (38.68%), and the incidence of axillary lymph node metastasis was statistically different among patients with different molecular subtypes (P<0.05). It was highest in those with luminal B [HER-2 (–)] (42 cases, 53.85%) or Luminal B [HER-2 (+)] type (15 cases, 46.88%), with no statistical difference between them (P>0.05), followed by Luminal A (19 cases, 32.76%), triple-negative (12 cases, 29.27%) and HER-2 over expression type (6 cases, 17.65%), successively; no significant difference was found in distribution of the molecular subtypes either in group of patients with involvement of 1 lymph node to 3 lymph nodes or ≥ 4 lymph nodes (both P>0.05), although the number of cases with Luminal B [HER-2 (+)] type was highest and HER-2 over- expression type was lowest in the former, while the number of cases with HER-2 over- expression type was highest and Luminal B [HER-2(+)] type was lowest in the latter. Conclusion: In breast IDC, molecular subtype has certain reference value for assessing axillary lymph node metastasis and judging disease status, and it can probably be used as a basis for making individualized diagnosis and treatment strategy.