Biological subtype predicts locoregional recurrence after postmastectomy radiotherapy in Chinese breast cancer patients
Biological subtype predicts locoregional recurrence after postmastectomy radiotherapy in Chinese breast cancer patients
复制标题
生物学亚型预测中国乳腺癌患者乳房切除术后放疗后的局部复发
DOI：
10.1002/cam4.2904
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发表时间：
2020-02-12
期刊：
影响因子：
4
通讯作者：
Guo, Xiaomao
中科院分区：
文献类型：
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作者：
Wang, Jiangfeng;Luo, Jurui;Guo, Xiaomao
目的探讨生物学亚型对乳腺癌术后放疗（PMRT）患者局部复发的影响。根据免疫组织化学染色特征，将患者分为：管腔A样、管腔B样、HER2阳性和三阴性乳腺癌（TNBC）。局部和区域复发（LRR）的累积发生率计算的竞争风险的方法和权力的预后因素进行了检查Gray的检验和测试的Fine和Gray。大约发生了34起LRR事件。对于Luminal A、Luminal B、HER2阳性和TNBC患者，5年LRR累积发生率分别为1.57%、4.09%、10.74%和10.28%。与Luminal A相比，HER2阳性亚型和TNBC的LRR风险显著增加（HR分别为5.034和5.188）。在单变量分析中，较高LRR的预测因素为HER2阳性亚型（HR = 4.43，P < .05）、TNBC（HR = 4.70，P < .05）和pN3（HR = 5.83，P < .05）。在多变量模型中，HER2阳性亚型（HR = 5.034，P <0.05）、TNBC（HR = 5.188，P <0.05）和pN3（HR = 9.607，P <0.01）是LRR的独立预测因子。在HER2阳性亚型患者中，未使用曲妥珠单抗的LRR与TNBC相似（未使用vs TNBC，17.88% vs 10.28%，P > .05），而使用曲妥珠单抗的LRR与Luminal A相似（与Luminal A，P > .05）。此外，内分泌治疗也显著降低了管腔型队列中LRR的发生率（未治疗vs治疗，6.25%vs 2.89%，HR = 0.365，P <0.1）。结论生物学亚型是中国乳腺癌患者PMRT中LRR的一个预后因素。
Aim To investigate the impact of biological subtypes in locoregional recurrence in Chinese breast cancer patients receiving postmastectomy radiotherapy (PMRT).Methods and Materials About 583 patients who received postmastectomy radiation between 2010 and 2012 were retrospectively analyzed. According to immunohistochemical staining profile, patients were classified into: Luminal A-like, Luminal B-like, HER2-positive, and triple-negative breast cancer (TNBC). Local and regional recurrence (LRR) cumulative incidences were calculated by competing risks methodology and the power of prognostic factors was examined by Gray's test and the test of Fine and Gray.Results The median follow-up was 70.9 months. About 34 LRR events occurred. For Luminal A, Luminal B, HER2-positive, and TNBC patients, the 5-year LRR cumulative incidence rates were 1.57%, 4.09%, 10.74%, and 10.28%. Compared with Luminal A, HER2-positive subtype and TNBC had a significant increased risk of LRR (HR was 5.034 and 5.188, respectively). In univariate analysis, predictive factors for higher LRR were HER2-positive subtype (HR = 4.43, P < .05), TNBC (HR = 4.70, P < .05), and pN3 (HR = 5.83, P < .05). In the multivariate model, HER2-positive subtype (HR = 5.034, P < .05), TNBC (HR = 5.188, P < .05), and pN3 (HR = 9.607, P < .01) were independent predictors of LRR. LRR without trastuzumab was similar to that of TNBC (without vs TNBC, 17.88% vs 10.28%, P > .05) in HER2-positive subtype patients, while LRR with trastuzumab was approximate to Luminal A (with vs Luminal A, P > .05). Additionally, endocrine therapy also significantly reduced LRR incidence in the luminal subtype cohort (without vs with therapy, 6.25% vs 2.89%, HR = 0.365, P < .1).Conclusions Biological subtype was a prognostic factor of LRR in the PMRT setting among Chinese breast cancer patients.