Prediction of Local Recurrence, Distant Metastases, and Death After Breast-Conserving Therapy in Early-Stage Invasive Breast Cancer Using a Five-Biomarker Panel
Prediction of Local Recurrence, Distant Metastases, and Death After Breast-Conserving Therapy in Early-Stage Invasive Breast Cancer Using a Five-Biomarker Panel
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DOI：
10.1200/jco.2008.21.7075
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发表时间：
2009-10-01
影响因子：
45.3
通讯作者：
Sutherland, Robert L.
中科院分区：
文献类型：
--
作者：
Millar, Ewan K. A.;Graham, Peter H.;Sutherland, Robert L.
目的 确定保乳治疗 (BCT) 后内在分子表型的临床效用，包括肿瘤切除术和全乳腺放疗，有或没有腔内增强放疗。 患者和方法 498 名浸润性乳腺癌患者被纳入一项有或没有瘤床放疗增强的 BCT 随机试验。肿瘤根据内在分子表型分类为管腔 A 或 B、HER-2、基底样，或使用五种生物标志物组进行未分类：雌激素受体、孕激素受体、HER-2、CK5/6 和表皮生长因子受体。使用 Kaplan-Meier 和 Cox 比例风险方法来确定与同侧乳腺肿瘤复发 (IBTR)、局部区域复发 (LRR)、远处无病生存 (DDFS) 和乳腺癌死亡的关系。结果中位随访时间为 84 个月。 394 例患者被分类为 Luminal A，23 例为 Luminal B，52 例为基础型，13 例为 HER-2，16 例为未分类。共有 24 例 IBTR（4.8%）、35 例 LRR（7%）、47 例远处转移（9.4%）和 37 例乳腺癌死亡（7.4%）。整个队列的总体 5 年无病率为：IBTR 97.4%、LRR 95.6%、DDFS 92.9% 和乳腺癌特异性死亡率 96.3%。 LRR (P = .012)、DDFS (P = .0035) 和乳腺癌特异性死亡 (P = .0482) 亚型之间的生存率存在显着差异，但 IBTR (P = .346) 则不然。结论 5 年和 10 年生存率因分子亚型而异。尽管这种方法提供了额外的信息来预测 IBTR、LRR、DDFS 时间和乳腺癌死亡时间，但其预测能力低于传统病理指标。该信息可能有助于与患者讨论 BCT 后的结果和规划管理。
PurposeTo determine the clinical utility of intrinsic molecular phenotype after breast-conserving therapy (BCT) with lumpectomy and whole-breast irradiation with or without a cavity boost.Patients and MethodsFour hundred ninety-eight patients with invasive breast cancer were enrolled into a randomized trial of BCT with or without a tumor bed radiation boost. Tumors were classified by intrinsic molecular phenotype as luminal A or B, HER-2, basal-like, or unclassified using a five-biomarker panel: estrogen receptor, progesterone receptor, HER-2, CK5/6, and epidermal growth factor receptor. Kaplan-Meier and Cox proportional hazards methodology were used to ascertain relationships to ipsilateral breast tumor recurrence (IBTR), locoregional recurrence (LRR), distant disease-free survival (DDFS), and death from breast cancer.ResultsMedian follow-up was 84 months. Three hundred ninety-four patients were classified as luminal A, 23 were luminal B, 52 were basal, 13 were HER-2, and 16 were unclassified. There were 24 IBTR (4.8%), 35 LRR (7%), 47 distant metastases (9.4%), and 37 breast cancer deaths (7.4%). The overall 5-year disease-free rates for the whole cohort were: IBTR 97.4%, LRR 95.6%, DDFS 92.9%, and breast cancer-specific death 96.3%. A significant difference was observed for survival between subtypes for LRR (P = .012), DDFS (P = .0035), and breast cancer-specific death (P = .0482), but not for IBTR (P = .346).ConclusionThe 5-year and 10-year survival rates varied according to molecular subtype. Although this approach provides additional information to predict time to IBTR, LRR, DDFS, and death from breast cancer, its predictive power is less than that of traditional pathologic indices. This information may be useful in discussing outcomes and planning management with patients after BCT.