The prognostic significance of multiple morphologic features and biologic markers in ductal carcinoma in situ of the breast - A study of a large cohort of patients treated with surgery alone
The prognostic significance of multiple morphologic features and biologic markers in ductal carcinoma in situ of the breast - A study of a large cohort of patients treated with surgery alone
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DOI：
10.1002/cncr.20260
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发表时间：
2004-06-01
期刊：
影响因子：
6.2
通讯作者：
Schwarting, R
中科院分区：
文献类型：
--
作者：
Cornfield, DB;Palazzo, JP;Schwarting, R
背景许多常规的组织病理学特征与单纯手术后导管内癌（DCIS）的复发相关，并被纳入范奈斯病理学分类和预后指数。据作者所知，在过去的十年中，人们对DCIS中许多生物标志物的预后意义知之甚少。我们分析了1982年至2000年期间151例因乳腺X线摄影诊断或偶然发现的DCIS而接受广泛局部切除术的患者的临床和病理资料。以局部疾病复发为终点，作者试图确定大量组织病理学参数以及生物学标志物（雌激素受体[ER]、孕激素受体[PR]、p53、HER-2/neu、Ki-67、p21和bcl-2）的预后意义，这些参数通过对当代或存档组织进行免疫组织化学染色来确定。中位随访时间为65个月，据报道，42例复发发生在确定性手术后11个月至97个月之间。在单因素分析中，肿瘤大小、范奈斯病理分类和坏死程度与复发率显著相关。肿瘤大小、坏死、核分级和粉刺坏死与疾病复发时间显著相关。没有一种生物标志物与复发率或疾病复发时间有显著相关性。在多变量分析中，发现只有大特纳大小（范奈斯2或3）和较高程度的坏死（范奈斯2或3）与复发率和复发时间显著相关。没有生物学标志物显示与复发显著相关。采用分类回归树分析和树形生存分析，PR > 3.5%和bcl-2 < 97.5%与肿瘤小（范奈斯1号）和肿瘤坏死程度高（范奈斯2或3号）的患者亚组的复发率较高相关。目前的研究结果证实了范奈斯分类系统中常规组织病理学参数在预测DCIS局部复发中的价值。使用传统的逻辑分析，没有发现各种生物标志物和疾病复发之间的显着相关性。(C)2004年美国癌症协会。
BACKGROUND. A number of conventional histopathologic features have been associated with recurrence of ductal carcinoma in situ (DCIS) after surgery alone and are included in the Van Nuys Pathologic Classification and Prognostic Index. To the authors' knowledge, very little is known regarding the prognostic significance of the many biologic markers that have been studied in DCIS in the past decade.METHODS. Clinical and pathologic data were analyzed from 151 patients who underwent wide local excision alone for DCIS that was diagnosed by mammography phy or as an incidental finding between 1982 and 2000. Using local disease recurrence as an endpoint, the authors sought to determine the prognostic significance of a large number of histopathologic parameters as well as biologic markers (estrogen receptor [ER], progesterone receptor [PR], p53, HER-2/neu, Ki-67, p21, and bcl-2), as determined by immunohistochemical staining of contemporary or archival tissue.RESULTS. With a median follow-up of 65 months, 42 recurrences were reported to occur between 11 months and 97 months after definitive surgery. In a univariate analysis, tumor size, Van Nuys pathologic classification, and degree of necrosis demonstrated significant correlations with the rate of recurrence. Tumor size, necrosis, nuclear grade, and comedonecrosis were found to be associated significantly with the time to disease recurrence. None of the biologic markers demonstrated a significant association with the rate of recurrence or the time to disease recurrence. In a multi-variate analysis, only large turner size (Van Nuys 2 or 3) and higher degrees of necrosis (Van Nuys 2 or 3) were found to be associated significantly with both the rate of recurrence and the time to recurrence. No biologic marker showed a significant correlation with recurrence. Using Classification and Regression-Tree Analysis and Tree-Structured Survival Analysis, PR > 3.5% and bcl-2 < 97.5% were associated with a higher recurrence rate in the subgroup of patients with small tumor size (Van Nuys size 1) and higher degrees of tumor necrosis (Van Nuys 2 or 3).CONCLUSIONS. The current results confirmed the value of conventional histopathologic parameters, as outlined in the Van Nuys classification system, in predicting local recurrence of DCIS. Using traditional logistic analyses, no significant correlation was found between a variety of biologic markers and disease recurrence. (C) 2004 American Cancer Society.