Use of ER/PR/HER2 subtypes in conjunction with the 2007 St Gallen Consensus Statement for early breast cancer
Use of ER/PR/HER2 subtypes in conjunction with the 2007 St Gallen Consensus Statement for early breast cancer
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DOI：
10.1186/1471-2407-10-228
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发表时间：
2010-05-21
期刊：
影响因子：
3.8
通讯作者：
Caggiano, Vincent
中科院分区：
文献类型：
--
作者：
Bauer, Katrina;Parise, Carol;Caggiano, Vincent
背景：2007 年圣加仑国际专家共识声明描述了三个风险类别，并提供了早期乳腺癌治疗的建议。这套关于如何最好地治疗原发性乳腺癌的建议得到了全世界临床医生的认可和使用。我们现在利用 ER/PR/HER2 亚型检查 2007 年圣加仑风险分类的五年生存率的变异性。方法：使用基于人口的加州癌症登记处，确定了 2000 年至 2006 年间诊断的 114,786 例 1-3 期浸润性乳腺癌病例。案例被分配为低、中或高风险类别。计算圣加仑三种风险类别和 ER/PR/HER2 亚型的五年相对生存率，以进一步区分。结果和讨论：有 9,124 例 (13%) 病例被归类为低风险，44,234 例 (65%) 病例被归类为中风险，14,340 例 (21%) 病例被归类为高风险。在中度风险组中，33,735 例 (76%) 淋巴结阴性（中度风险 2），10,499 例 (24%) 淋巴结阳性（中度风险 3）。对于高风险组，6,149 名（43%）有 1 至 3 个腋窝淋巴结阳性（高风险 4），8,191 名（57%）有 4 个或更多阳性腋窝淋巴结（高风险 5）。使用五年相对生存率作为主要标准，我们发现以下内容： a) 低风险和中风险类别之间几乎没有差异； b) 在中风险和高风险类别中使用 ER/PR/HER2 亚型，将每个亚型分为五年生存率较高的组（ER 阳性）和生存率较差的组（ER 阴性），无论 HER2 状态如何； c) 当检查具有四个或更多腋窝淋巴结阳性的 ER/PR/HER2 亚型时，高风险类别的异质性最为明显； (d) HER2 阳性并不总是意味着较差的生存率，正如在将三重阳性亚型 (ER+/PR+/HER2+) 与三重阴性亚型 (ER-/PR-/HER2-) 进行比较时所注意到的那样； (e) ER 阴性似乎比 HER2 阳性更能预测不良生存。结论：ER/PR/HER2 亚型的使用凸显了 2007 年圣加仑声明中中风险和高风险类别的显着异质性。建议使用 ER/PR/HER2 亚型以及与乳腺癌分子分类的相关性。
Background: The 2007 St Gallen international expert consensus statement describes three risk categories and provides recommendations for treatment of early breast cancer. The set of recommendations on how to best treat primary breast cancer is recognized and used by clinicians worldwide. We now examine the variability of five-year survival of the 2007 St Gallen Risk Classifications utilizing the ER/PR/HER2 subtypes.Methods: Using the population-based California Cancer Registry, 114,786 incident cases of Stages 1-3 invasive breast cancer diagnosed between 2000 and 2006 were identified. Cases were assigned to Low, Intermediate, or High Risk categories. Five-year-relative survival was computed for the three St Gallen risk categories and for the ER/PR/HER2 subtypes for further differentiation.Results and Discussion: There were 9,124 (13%) cases classified as Low Risk, 44,234 (65%) cases as Intermediate Risk, and 14,340 (21%) as High Risk. Within the Intermediate Risk group, 33,735 (76%) were node-negative (Intermediate Risk 2) and 10,499 (24%) were node-positive (Intermediate Risk 3). For the High Risk group, 6,149 (43%) had 1 to 3 positive axillary lymph nodes (High Risk 4) and 8,191 (57%) had four or more positive lymph nodes (High Risk 5).Using five-year relative survival as the principal criterion, we found the following: a) There was very little difference between the Low Risk and Intermediate Risk categories; b) Use of the ER/PR/HER2 subtypes within the Intermediate and High Risk categories separated each into a group with better five-year survival (ER-positive) and a group with worse survival (ER-negative), irrespective of HER2-status; c) The heterogeneity of the High Risk category was most evident when one examined the ER/PR/HER2 subtypes with four or more positive axillary lymph nodes; (d) HER2-positivity did not always translate to worse survival, as noted when one compared the triple positive subtype (ER+/PR+/HER2+) to the triple negative subtype (ER-/PR-/HER2-); and (e) ER-negativity appeared to be a stronger predictor of poor survival than HER2-positivity.Conclusion: The use of ER/PR/HER2 subtype highlights the marked heterogeneity of the Intermediate and High Risk categories of the 2007 St Gallen statements. The use of ER/PR/HER2 subtypes and correlation with molecular classification of breast cancer is recommended.