[摘要] 目的: 探讨不同分子分型乳腺癌患者预后与Ⅱ、Ⅲ期乳腺癌淋巴结转移率的相关性。方法: 回顾性分析2011 年1 月至2016 年1 月在南京医科大学附属常州第二人民医院311 例确诊为Ⅱ、Ⅲ期乳腺癌并首选手术治疗的乳腺癌患者的临床资料，依据雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体-2（HER2）和Ki-67 增殖指数分为Luminal A型、Luminal B 型、HER2 过表达型和三阴型（TNBC）4 型。通过卡方检验分析不同分组间患者的临床特征；通过Kaplan-Meier 生存曲线评估腋淋巴结转移率（LNR）对各型乳腺癌患者预后的影响，以及相同LNR的不同分子分型的乳腺癌预后的差异，通过Spearman 相关分析LNR与Ki-67 增殖指数的相关性。结果: 不同分子分型在患者年龄、绝经情况、肿瘤大小、淋巴结状态及转移部位等临床特征差异无统计学意义（均P>0.05）。LNR为0 或>0.65 的4 组分子分型的无病生存时间（DFS）差异无统计学意义（χ2=3.581、2.808，均P>0.05），LNR介于0.01~0.65 的4 组分子分型的DFS差异有统计学意义（χ2=24.366、8.169，均P<0.05）。LNR与Ki-67 增殖指数呈正相关（r=0.125，P<0.05）。多因素Cox 回归分析显示，乳腺癌患者预后与分子分型（RR=1.179，95%CI=1.023~1.358；χ2=5.165，P<0.05）、LNR（RR=1.137，95%CI=0.985~0.999；χ2=5.589，P<0.05）及Ki-67 增殖指数（RR=0.992，95%CI=1.022~1.264；χ2=5.623，P<0.05）有关。结论: LNR是Ⅱ、Ⅲ期乳腺癌预后的重要影响因素，相同LNR的不同分子分型预后差异显著，LNR与Ki-67 增殖指数呈正相关。

[Abstract] Objective: To discuss the relationship between lymph node metastasis rate and the prognosis of patients with stage II and III breast cancer with different molecular subtypes. Methods: The clinical data of 311 patients diagnosed with stage II and III breast cancer, who received preferred surgical treatment in Changzhou Second People's Hospital Affiliated to Nanjing Medical University from January 2011 to January 2016, were retrospectively analyzed. According to the levels of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2) and Ki-67 proliferation index, the patients were divided into four groups, namely,Luminal A, Luminal B, HER2 over-expression and triple negative breast cancer (TNBC). Chi-square test was used to analyze the clinical characteristics of patients in different groups. Kaplan-Meier survival curve was used to evaluate the prognostic impact of axillary lymph node metastasis rate (LNR) on patients with different types of breast cancer, and the prognostic differences among breast cancer patients with different molecular subtypes under the same LNR. Spearman correlation was used to analyze the correlation between LNR and Ki-67 proliferation index. Results: There were no significant differences in clinical characteristics of age, menopause,tumor size, lymph node status and metastasis site among BC patients with different molecular subtypes (all P>0.05). There was no significant difference in disease-free survival (DFS) among the four subgroups with LNR of 0 or >0.65 (χ2=3.581, 2.808, all P>0.05); and there was significant difference in DFS among the four subgroups with LNR between 0.01 and 0.65 (χ2=24.366, 8.169, all P<0.05).LNR was positively correlated with the Ki-67 proliferation index (r=0.125, P<0.05). Multivariate Cox regression analysis showed that the prognosis of breast cancer patients was related to molecular subtypes (RR=1.179, 95%CI=1.023-1.358; χ2=5.165, P<0.05), LNR (RR =1.137, 95%CI=0.985-0.999; χ2=5.589, P<0.05) and Ki-67 proliferation index (RR=0.992, 95%CI=1.022-1.264; χ2=5.623，P<0.05).Conclusion: LNR is an important prognostic factor for stage II and III breast cancer. With the same LNR, the prognosis of breast cancer patients with different molecular subtypes varies greatly. LNR is positively correlated with Ki-67 proliferation index.

国家自然科学基金资助项目(No.81502294)；常州市科技计划项目（No.CJ20159044）