为什么her2型乳腺癌术后转移风险高

李帆 副主任医师 晋中市第一人民医院 三甲

擅长：擅长领域：掌握最新的肺癌，乳腺癌，胃肠道肿瘤，妇科肿瘤等恶性肿瘤的诊疗知识，善于与患者沟通，指导患者健康饮食

提问

her2型乳腺癌术后转移风险高可能是由基因过度表达、激素受体阴性、淋巴结转移、肿瘤大小、手术不彻底等病因所致。这些因素可能导致肿瘤细胞更容易扩散和复发。患者应密切关注病情变化，定期复查，以便早期发现和处理任何潜在的转移。
1.基因过度表达
HER2基因过度表达会导致细胞增殖失控，进而促进肿瘤生长和扩散。过多的HER2蛋白可以激活信号通路，刺激细胞分裂并抑制凋亡，从而增加乳腺癌复发和转移的风险。针对HER2基因扩增的靶向治疗，如曲妥珠单抗注射液，能够阻断HER2介导的信号通路，降低细胞增殖率，对控制HER2阳性乳腺癌的进展有较好的效果。
2.激素受体阴性
激素受体阴性意味着雌激素和孕激素不能有效地调节细胞活动，这可能导致细胞增生和恶变。没有激素受体的细胞无法响应正常的调控机制，因此更容易发生异常增长和扩散。内分泌治疗是常用的乳腺癌治疗方法之一，对于激素受体阳性的患者有效。通过药物如他莫昔芬片、枸橼酸氯米芬胶囊等来干扰雌激素的作用，减少HER2型乳腺癌细胞的存活和繁殖。
3.淋巴结转移
Lymph node metastasis refers to the spread of cancer cells from their original site to nearby lymph nodes, which can lead to further dissemination and recurrence. The presence of lymph node involvement indicates a higher risk of distant metastases. Complete removal of involved lymph nodes is crucial for improving prognosis and reducing the likelihood of recurrent disease. This typically involves sentinel lymph node biopsy or axillary lymph node dissection during surgery.
4.肿瘤大小
Tumor size is an independent predictor of metastatic potential because larger tumors have a greater capacity for invasion and dissemination. Smaller tumors may be more amenable to local treatment approaches, whereas larger ones often require more extensive interventions to prevent recurrence.Surgical excision with negative margins is the primary method for treating HER2-positive breast cancers based on tumor size. For example, wide local excision or quadrantectomy may be appropriate for smaller tumors, while mastectomy might be necessary if the tumor is large or has other aggressive features.
5.手术不彻底
If the operation is not thorough, some residual tumor cells may remain in the breast tissue, which could later develop into new tumors. Incomplete removal provides a foundation for future growth and proliferation of these cells, increasing the risk of recurrence and metastasis.To minimize the risk of recurrence due to surgical incompleteness, it is essential to work closely with the surgeon to ensure that all visible tumor is removed during the initial procedure. Postoperative imaging such as mammography or MRI may also help evaluate the adequacy of the surgical intervention.
定期复查对于监测HER2型乳腺癌至关重要，建议每年进行一次乳腺X线摄影术或磁共振成像以评估病情变化。此外，保持良好的生活习惯，包括均衡饮食、适量运动以及避免吸烟和过量饮酒，也有助于降低疾病复发的风险。