六十一歲母親被診斷為乳癌，手術後需要接受化療和標靶治療嗎？-腫瘤科

乳癌問題請教？

---

醫師您好，想請教您問題家母目前61歲，最近確診乳癌(管腔B2型)，剛做完部分乳房切除及前哨淋巴化驗(4顆)，無淋巴轉移，手術前無做術前治療。
病理報告如下:
1、部分切除(6*4.8*4.8cm)並檢驗前哨淋巴
2、Overlying skin:2.2*0.5cm in dimension
3、Additional margin :2.2*0.5*0.5cm in size
4、Tumor: 2*1.5*1.5cm in sizeMicroscopic Examination:
1、Histologic type: Invasive ductal carcinoma
2、Size of invasive carcinoma(mm) :21*16*15 mm in size
3、Histologic grade (Nottingham histologic score): Grade2*Tubule formation :3*Nuclear pleomorphism :2*Mitotic count:1
4、Extent of tumor:Skin involvement:AbsentChest wall invasion deeper than pectoralis muscle : cannot be assessed
5、Pathologic staging (pTNM:)(1)Primary Tumor(pT):Snomed: 04020-R-M85003 08710-R-M00100pT2:Tumor more than 20 mm but not more than 50 mm in greatest dimension(2)Regional Lymph Nodes (pN):pN0(i-):No regional lymph node metastasis histologically, negative IHC*No. examined:4*No. examined by CK (AE1/AE3) immunostain :4*No. macrometastases (>2 mm): 0*No. micrometastases (>0.2~2 mm and/or >200 cells): 0*No. isolated tumor cells (<=0.2mm and <=200 cells): 0
6、Margin :Negative
7、Lymphovascular invasion :Absent
8、Perineural invasion :Absent
9、Hormone study:ER:positive(>90%)PR:positive(>90%)HER-2/Neu: positive (3+/3+,only for Her-2 FISH study reference)10、Ki67: Stained in 20-30% of tumor cells手術前血液報告CEA<1.73CA-153 為 8.9想請教醫師家母復發風險高嗎?因醫師建議化療、標靶都要做，想請教醫師是否一定要接受標靶治療呢?三陽性乳癌 Ki67指標20-30算高嗎?是否也屬於容易復發的狀況呢?另外想請教醫師三陽性乳癌 跟 HER-2陽性型乳癌，兩者惡性度有一樣嗎?因為我上網了解HER2陽性行乳癌分別有(三陽性)跟(ER及PR皆陰性但HER-2陽性)兩種，這兩種差很多嗎?感謝醫師撥冗回覆，感恩!

---

CC，30~39歲女性，詢問日期：2022/11/06