Personalizing Breast Cancer Staging by the Inclusion of ER, PR, and HER2
Personalizing Breast Cancer Staging by the Inclusion of ER, PR, and HER2
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DOI：
10.1001/jamasurg.2013.3181
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发表时间：
2014-02-01
期刊：
影响因子：
16.9
通讯作者：
Giuliano, Armando E.
中科院分区：
文献类型：
--
作者：
Bagaria, Sanjay P.;Ray, Partha S.;Giuliano, Armando E.
重要性非解剖因素，如组织学分级和生物标志物，可以指导乳腺癌的管理，但不包括在目前的TNM分期system.ObjectiveTo使用作为一个例子，三阴性表型（TNP）定义的缺乏雌激素受体（ER），孕激素受体（PR），和人表皮生长因子2（HER2），以检查这种纳入是否提高乳腺癌TNM分期的预后准确性。设计，地点，和参与者从一个前瞻性的机构数据库中识别出1991年1月1日至2008年12月31日诊断为原发性浸润性导管乳腺癌的妇女。排除接受新辅助治疗的患者、分期信息不完整的患者或肿瘤缺乏ER、PR和HER2数据的患者。乳腺癌进行了分类TNM分期和TNP的存在或不存在。主要结局和措施总生存率在5 years.RESULTS数据库审查确定了1842连续合格的乳腺癌患者。当患者按TNM分期分层时，TNP乳腺癌患者的总生存曲线与非TNP乳腺癌患者的总生存曲线相匹配，后者的TNM分期高出1期。多变量分析显示，TNP状态是一个强有力的预后变量，似然比检验显示，纳入TNP的TNM分期系统的预后准确性上级目前的TNM分期系统（P < .001）。一个TNM分期系统，包括TNP减少了15%.CONCLUSIONS和相关性的国际公认的和容易重复的检查ER，PR和HER2状态证实了如何非解剖因素可以提高乳腺癌分期的预后准确性。
IMPORTANCE Nonanatomic factors, such as histologic grade and biomarkers, can guide breast cancer management but are not included in the current TNM staging system.OBJECTIVE To use as an example the triple-negative phenotype (TNP) defined by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) to examine whether such inclusion improves the prognostic accuracy of TNM staging for breast cancer.DESIGN, SETTING, AND PARTICIPANTS Women diagnosed with primary invasive ductal breast cancer from January 1,1991, through December 31, 2008, were identified from a prospective institutional database. Excluded were patients who received neoadjuvant therapy, those whose staging information was incomplete, or those whose tumor lacked ER, PR, and HER2 data. Breast cancers were categorized by TNM stage and by the presence or absence of TNP.MAIN OUTCOMES AND MEASURES Overall survival at 5 years.RESULTS Database review identified 1842 consecutive eligible patients with breast cancer. When patients were stratified by TNM stage, overall survival curves for those with TNP breast cancer matched those for patients whose non-TNP breast cancer was 1 TNM stage higher. Multivariable analysis showed that TNP status was a powerful prognostic variable, and the likelihood ratio test revealed that the prognostic accuracy of the TNM staging system that incorporated TNP was superior to the current TNM staging system (P < .001). A TNM staging system that incorporated TNP reduced early-stage compression by 15%.CONCLUSIONS AND RELEVANCE The internationally recognized and easily reproducible examination of ER, PR, and HER2 status exemplifies how nonanatomic factors can improve the prognostic accuracy of breast cancer staging.