Breast Cancer Molecular Subtype as a Predictor of the Utility of Preoperative MRI
Breast Cancer Molecular Subtype as a Predictor of the Utility of Preoperative MRI
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DOI：
10.2214/ajr.14.13666
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发表时间：
2015-06-01
影响因子：
5
通讯作者：
Wynn, Ralph
中科院分区：
文献类型：
--
作者：
Ha, Richard;Jin, Brian;Wynn, Ralph
OBJECTIVE.本研究的目的是辨别乳腺癌的分子亚型，一个已知的预后指标，是否可以用来选择患者的最高可能性有临床意义的额外的结果乳腺MRI。2010年1月至2013年12月的数据库审查确定了299例接受术前乳腺MRI的患者，肿瘤可分为分子亚型。基于免疫组织化学染色替代物将亚型分类为管腔A（激素受体[ER或PR]阳性，ERBB 2 [以前为HER 2或HER 2/neu]阴性）、管腔B（激素受体阳性，ERBB 2阳性）、ERBB 2（激素受体阴性，ERBB 2阳性）或基底（激素受体和ERBB 2阴性）。单变量和多变量逻辑回归分析用于确定亚型和其他乳腺MRI结果之间的相关性，包括多中心或多灶性疾病、对侧疾病、胸壁受累、皮肤和乳头受累以及内乳和腋窝淋巴结病。亚型分布为管腔A型，70.6%（211/299）;管腔B型，14.1%（42/299）; ERBB 2型，5.4%（16/299）;基底型，10.0%（30/299）。ERBB 2和管腔型B亚型与多中心性疾病（25.0%和26.2%）、多灶性疾病（37.5%和35.7%）和腋窝疾病（50.0%和45.2%）的相关性高于管腔型A型癌症（多中心性疾病，10.9%;多灶性疾病20.4%;腋窝疾病，22.7%）（p < 0.001）。在多变量分析中，在控制了患者年龄、肿瘤大小和核分级后，ERBB 2过表达肿瘤患者发生多中心疾病的可能性是管腔A型肿瘤患者的2.4倍。（p = 0.016），多灶性疾病的可能性为2.0倍（p = 0.024），皮肤和乳头受累的可能性是1.7倍（p = 0.013），腋窝疾病的可能性是1.9倍（p = 0.011）。术前MRI可能对ERBB 2过表达的肿瘤患者最有利，因为存在其他疾病的可能性增加。
OBJECTIVE. The purpose of this study was to discern whether breast cancer molecular subtype, a known prognostic indicator, can be used to select patients with the highest likelihood of having clinically significant additional findings on breast MRI.MATERIALS AND METHODS. A database review from January 2010 through December 2013 identified 299 patients who underwent preoperative breast MRI with tumors classifiable into molecular subtypes. Subtypes were classified on the basis of immunohistochemical staining surrogates as luminal A (hormone receptor [ER or PR] positive, ERBB2 [formerly HER2 or HER2/neu] negative, luminal B (hormone receptor positive, ERBB2 positive), ERBB2 (hormone receptor negative, ERBB2 positive), or basal (hormone receptor and ERBB2 negative). Univariate and multivariate logistic regression analyses were used to determine the association between subtype and additional breast MRI findings, including multicentric or multifocal disease, contralateral disease, chest wall involvement, skin and nipple involvement, and internal mammary and axillary lymphadenopathy.RESULTS. The subtype distribution was luminal A, 70.6% (211/299); luminal B, 14.1% (42/299); ERBB2, 5.4% (16/299); and basal, 10.0% (30/299). ERBB2 and luminal B subtypes were more often associated with multicentric disease (25.0% and 26.2%), multifocal disease (37.5% and 35.7%), and axillary disease (50.0% and 45.2%) than were luminal A cancers (multicentric disease, 10.9%; multifocal disease 20.4%; axillary disease, 22.7%) (p < 0.001). In multivariate analysis, after control for patient age, tumor size, and nuclear grade, patients with ERBB2-overexpressing tumors were 2.4 times as likely as patients with luminal A tumors to have multicentric disease (p = 0.016), 2.0 times as likely to have multifocal disease (p = 0.024), 1.7 times as likely to have skin and nipple involvement (p = 0.013), and 1.9 times as likely to have axillary disease (p = 0.011).CONCLUSION. Preoperative MRI may most benefit patients with tumors with ERBB2 overexpression because of the increased likelihood of the presence of additional disease.