Back to Basics: Traditional Nottingham Grade Mitotic Counts Alone are Significant in Predicting Survival in Invasive Breast Carcinoma
Back to Basics: Traditional Nottingham Grade Mitotic Counts Alone are Significant in Predicting Survival in Invasive Breast Carcinoma
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DOI：
10.1245/s10434-015-4616-y
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Pockaj, Barbara A.
中科院分区：
文献类型：
--
作者：
Chang, James M.;McCullough, Ann E.;Pockaj, Barbara A.
背景较新的乳腺癌多基因分子分析检测在很大程度上依赖于增殖基因的定量，而传统的组织学分级报告有丝分裂计数。浸润性乳腺癌的有丝分裂活性可能被低估;因此，评估有丝分裂评分在预测预后中的预后意义。对新诊断的雌激素受体阳性（ER+）、HER 2阴性（HER 2-）单侧浸润性乳腺癌的单一机构队列进行回顾性分析。将三部分诺丁汉联合组织学分级的有丝分裂评分与临床参数进行比较。在Olympus BX 50显微镜上计数有丝分裂，并根据观察到的有丝分裂评分1-3分。共确定了1292例ER+、HER 2-浸润性乳腺癌患者，中位随访时间为2.6年（范围0-14年）。较高的有丝分裂评分与较年轻、肿瘤较大、血管淋巴管浸润、淋巴结阳性、分期较高以及激素和细胞毒化疗的使用显著相关。有丝分裂评分在局部/区域复发建模时间（p = 0.02）、无复发生存/RFS（p < 0.001）和总生存/OS（p = 0.01）方面具有显著性，有丝分裂评分越高，预后越差。较高的有丝分裂评分与中/高风险Oncotype Dx复发评分显著相关（p = 0.009）。雌激素受体阳性浸润性乳腺癌的第一代分子谱分析从将增殖基因量化为单个评分中获得其大部分预测能力。有时在大量的分子数据中被忽视，经过时间检验的有丝分裂计数在诺丁汉联合组织学分级中是一个很好的生存预测因子。
Background. Newer multigene molecular profiling assays for breast carcinoma rely heavily on the quantification of genes of proliferation, whereas traditional histological grading reports the mitotic count. The mitotic activity of invasive breast carcinomas may be undervalued; therefore, an evaluation of the prognostic significance of mitotic score in predicting prognosis was performed.Methods. Retrospective analysis of a single institutional cohort of newly diagnosed estrogen receptor positive (ER+), HER2 negative (HER2-) unilateral invasive breast carcinomas was performed. Mitotic scores from the 3-part Nottingham combined histological grade were compared with clinical parameters. Mitoses were counted on Olympus BX50 microscopes and assigned scores of 1-3 based on observed mitoses.Results. A total of 1292 ER+, HER2- invasive breast carcinoma patients were identified, with a median followup time of 2.6 years (range 0-14 years). Higher mitotic score was significantly associated with younger age, larger tumor size, angiolymphatic invasion, node-positive disease, higher stage, and the use of hormonal and cytotoxic chemotherapy. Mitotic score was significant in modeling time to local/regional recurrence (p = 0.02), recurrencefree survival/RFS (p < 0.001), and overall survival/OS (p = 0.01) with higher mitotic scores associated with worse outcomes. Higher mitotic score correlated significantly with intermediate/high risk Oncotype Dx recurrence scores (p = 0.009).Conclusions. First-generation molecular profiling assays for estrogen receptor positive invasive breast carcinomas derive much of their predictive power from quantifying genes of proliferation into a single score. Sometimes overlooked in the profusion of molecular data, the time-tested, mitotic count in the Nottingham combined histological grade is a good single-parameter predictor of survival.