A retrospective study of breast cancer subtypes: the risk of relapse and the relations with treatments
A retrospective study of breast cancer subtypes: the risk of relapse and the relations with treatments
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乳腺癌亚型的回顾性研究：复发风险及其与治疗的关系
DOI：
10.1007/s10549-011-1709-6
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发表时间：
2011-11-01
影响因子：
3.8
通讯作者：
Niu, Yun
中科院分区：
文献类型：
--
作者：
Wang, Yahong;Yin, Quangui;Niu, Yun
免疫组织化学标记物通常用于将乳腺癌分类为生物学上不同且表现不同的亚型。本研究的目的是评估使用免疫组化检测分类的乳腺癌主要亚型患者的复发率，并调查过去几年中治疗的获益模式。研究人群包括2,118例原发性可手术乳腺癌患者，均为非特异性浸润性导管癌，中位年龄为53.2岁。所有患者均接受局部和/或全身治疗。回顾性分析其临床病理特征和临床结局。采用免疫组化法检测雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER 2）、表皮生长因子受体（EGFR）和细胞角蛋白5/6的表达。所有患者分为以下类别：管腔A型、管腔B型、HER 2过表达型、基底细胞样型和未分类亚型。Ki-67在管腔A型中表达。中位随访时间为67.9个月。管腔型A肿瘤复发率最低（12.7%，P < 0.001），而管腔型B、HER 2过表达和基底细胞样亚型与复发风险增加相关（15.7，19.1，20.9%）。分子亚型仍具有独立的预后意义（P< 0.001）。在Luminal A亚型中，连续放疗可降低复发风险（P= 0.005），Ki 67阳性是复发的高危因素（P< 0.001），辅助化疗可降低高危因素患者的复发率（P< 0.001）。辅助激素治疗对ER阳性的肿瘤是有效的（P< 0.001）。乳腺癌的分子亚型可以可靠地识别复发风险，并在治疗决策中具有重要意义。该模型结合了亚型和临床病理学，是一个显著的进步。管腔A型肿瘤可能代表两个不同的亚群，表现出不同的预后和治疗反应。
Immunohistochemical markers are often used to classify breast cancer into subtypes that are biologically distinct and behave differently. The aim of this study was to estimate relapse for patients with the major subtypes of breast cancer as classified using immunohistochemical assay and to investigate the patterns of benefit from the therapies over the past years. The study population included primary, operable 2,118 breast cancer patients, all non-specific infiltrative ductal carcinoma, with the median age of 53.2 years. All patients underwent local and/or systemic treatments. The clinicopathological characteristics and clinical outcomes were retrospectively reviewed. The expression of estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), and cytokeratin 5/6 were analyzed by immunohistochemistry. All patients were classified into the following categories: luminal A, luminal B, HER2 overexpressing, basal-like, and unclassified subtypes. Ki-67 was detected in luminal A subtype. The median follow-up time was 67.9 months. Luminal A tumors had the lowest rate of relapse (12.7%,P< 0.001), while luminal B, HER2 overexpression, and basal-like subtypes were associated with an increased risk of relapse (15.7, 19.1, 20.9%). Molecular subtypes retained independent prognostic significance (P< 0.001). In luminal A subtype, adjunctive radiotherapy could decrease the risk of relapse (P= 0.005), Ki67 positive was a high-risk factor for relapse (P< 0.001), and adjuvant chemotherapies could reduce the relapse for the patients with risk factors (P< 0.001). Adjuvant hormone therapy was an effective treatment for ER-positive tumors (P< 0.001). Molecular subtypes of breast cancer could robustly identify the risk of recurrence and were significant in therapeutic decision making. The model combined subtype and clinical pathology was a significant improvement. Luminal A tumors might represent two distinct subsets which demonstrated distinct prognosis and therapy response.