Comparison between screen-detected and symptomatic breast cancers according to molecular subtypes
Comparison between screen-detected and symptomatic breast cancers according to molecular subtypes
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DOI：
10.1007/s10549-011-1836-0
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发表时间：
2012-01-01
影响因子：
3.8
通讯作者：
Yang, Jung-Hyun
中科院分区：
文献类型：
--
作者：
Kim, Jiyoung;Lee, SeKyung;Yang, Jung-Hyun
乳腺癌筛查计划可以发现早期癌症，从而降低乳腺癌死亡率。我们研究了筛查发现的浸润性乳腺癌与有症状的乳腺癌的临床病理特征和预后。我们根据分子亚型（管腔A、管腔B、Her 2和三阴性）比较结果，目的是确定筛查在每个亚型中的作用。从2002年1月至2008年6月，在三星医疗中心接受手术治疗浸润性导管癌的3,141例患者被纳入。其中，筛查出1,025名患者，筛查2年以上或从未筛查过的患者有2,116名出现症状。我们回顾性分析了临床和病理资料。与症状性乳腺癌相比，筛查发现的乳腺癌与年龄较大、肿瘤较小、受体阳性率较高、淋巴结受累较少、分期较早以及死亡率较低有关（P < 0.001）。根据分子亚型，管腔A型最常见（63.6%），与症状性肿瘤相比，在筛查检测的肿瘤中显示出最明显的生存获益（5年OS：99.7 vs. 96.5%，5年DFS：96.4 vs. 90.7%）。仅在管腔A亚型中，在调整协变量后，筛查检测与总体和无病生存结局的改善独立相关（HR 0.32，P = 0.035; HR 0.58，P = 0.020）。不同分子亚型分布的病理学特征如肿瘤大小、淋巴结状态、分级和诊断年龄的差异可能解释筛查发现乳腺癌患者的生存优势。筛查程序似乎具有不同的疗效，这取决于乳腺癌的分子亚型，特别是在管腔A亚型中，筛查检测本身作为独立的预后因素。
Breast cancer screening programs make it possible to detect early cancer, thus reducing breast cancer mortality. We studied the clinicopathologic characteristics and prognosis of screen-detected invasive breast cancer compared with symptomatic breast cancer. And we compared the result according to molecular subtypes (luminal A, luminal B, Her2, and triple negative), with the goal of identifying the role of screening in each subtypes. From January 2002 to June 2008, 3,141 patients who underwent surgery for the treatment of invasive ductal carcinoma at Samsung Medical Center were included. Among them, 1,025 patients were screen-detected, and 2,116 patients who were screened over 2 years or never were symptomatic. We retrospectively reviewed the clinical and pathologic data. Screen-detected breast cancer was associated with older age, smaller tumor size, more hormone-receptor positive, less lymph node involvement, earlier stage, and reduced mortality compared with symptomatic breast cancer (P < 0.001). According to the molecular subtype, luminal A was most common (63.6%) and showed the most obvious survival benefit in screen-detected tumors in comparison with symptomatic tumors (5-year OS: 99.7 vs. 96.5%, 5-year DFS: 96.4 vs. 90.7%). Screen detection was independently associated with improved overall and disease-free survival outcomes after adjustment for covariates (HR 0.32, P = 0.035; HR 0.58, P = 0.020, respectively) only in the luminal A subtype. Differences in pathological features such as tumor size, nodal status, grade, and age at diagnosis with different molecular subtype distributions may explain the survival advantage of patients with screen-detected breast cancer. Screening programs seem to have a different efficacy depending on the molecular subtype of the breast cancer, especially in the luminal A subtype, for which screen detection acts as an independent prognostic factor itself.