Breast Cancer Subtypes as Defined by the Estrogen Receptor (ER), Progesterone Receptor (PR), and the Human Epidermal Growth Factor Receptor 2 (HER2) among Women with Invasive Breast Cancer in California, 1999-2004
Breast Cancer Subtypes as Defined by the Estrogen Receptor (ER), Progesterone Receptor (PR), and the Human Epidermal Growth Factor Receptor 2 (HER2) among Women with Invasive Breast Cancer in California, 1999-2004
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DOI：
10.1111/j.1524-4741.2009.00822.x
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发表时间：
2009-11-01
期刊：
影响因子：
2.1
通讯作者：
Caggiano, Vincent
中科院分区：
文献类型：
--
作者：
Parise, Carol A.;Bauer, Katrina R.;Caggiano, Vincent
对乳腺癌分子谱或生物标志物亚型的研究主要集中在雌激素受体阴性/孕激素受体阴性/人表皮生长因子受体2阴性(ER-/PR-/HER2-)和ER-/PR-/HER2+亚型。对其他亚型的流行病学或临床结果知之甚少。本研究检测浸润性乳腺癌患者ER/PR/HER2的八种组合。研究了每种亚型的5年相对生存率和人口统计学、社会经济学和肿瘤特征的分布情况。利用加州癌症登记中心，61,309名患有原发浸润性乳腺癌的女性根据ER/PR/HER2状态进行了分类。计算了这八种亚型的五年相对生存率。使用双变量分析来评估病例在所有亚型中的分布。多因素Logistic回归用于计算5个亚型中存活率最好和最差之一的调整后的赔率。生存率从96%(ER+/PR+/HER2-)到76%(ER-/PR-/HER2+和ER-/PR-/HER2-)不等。生存最差的4个亚型均为ER阴性。年龄在50岁以下的女性，非西班牙裔黑人或西班牙裔，属于最低的SES组，并且有未分化的IV期肿瘤，在ER-/PR-/HER2+和三阴性(ER-/PR-/HER2-)亚型中过度表达。亚太地区岛民患ER-/PR-/HER2+亚型的几率增加(OR=1.41；95%可信区间=1.26-1.57)。III期肿瘤(OR=1.25；95%CI=1.08~1.44)和IV期肿瘤(OR=1.58；95%CI=1.27~1.98)发生ER-/PR-/HER2+的几率高于I期肿瘤。IV期肿瘤(OR=0.54；95%CI=0.44-0.67)显著降低ER-/PR-/HER2-亚型的发生几率。低分化和未分化肿瘤为ER-/PR-/HER2-或ER-/PR-/HER2+的可能性是高分化肿瘤的20倍以上。这八种亚型在生存、人口学和肿瘤特征方面有相当大的差异。我们建议将乳腺癌报告为ER/PR/HER2亚型，并准确记录人口统计学和肿瘤特征。
Breast cancer research examining either molecular profiles or biomarker subtypes has focused on the estrogen receptor negative/progesterone receptor negative/human epidermal growth factor receptor 2 negative (ER-/PR-/HER2-) and ER-/PR-/HER2+ subtypes. Less is known about the epidemiology or clinical outcome of the other subtypes. This study examines the eight combinations of ER/PR/HER2 in patients with invasive breast cancer. The 5-year relative survival and the distribution among demographic, socioeconomic, and tumor characteristics of each of the subtypes are examined. Using the California Cancer Registry, 61,309 women with primary invasive breast cancer were classified according to ER/PR/HER2 status. Five-year relative survival was computed for the eight subtypes. Bivariate analyses were used to assess the distribution of cases across all subtypes. Multivariate logistic regression was used to compute the adjusted odds of having one of the five subtypes with the best and worst survival. Survival varied from 96% (ER+/PR+/HER2-) to 76% (ER-/PR-/HER2+ and ER-/PR-/HER2-). The four subtypes with the poorest survival were all ER negative. Women who were younger than age 50, non-Hispanic black or Hispanic, of the lowest SES groups, and had stage IV tumors that were undifferentiated were overrepresented in ER-/PR-/HER2+ and triple negative (ER-/PR-/HER2-) subtypes. Asian Pacific Islanders had increased odds (OR = 1.41; 95% confidence interval [CI] = 1.26-1.57) of having the ER-/PR-/HER2+ subtype. Stage III tumors (OR = 1.25; 95% CI = 1.08-1.44) and stage IV tumors (OR = 1.58; 95% CI = 1.27-1.98) had higher odds than stage I tumors of being ER-/PR-/HER2+. Stage IV tumors (OR = 0.54; 95% CI = 0.44-0.67) strongly decreased the odds of the ER-/PR-/HER2- subtype. Poorly differentiated and undifferentiated tumors were over 20 times as likely as well-differentiated tumors of being ER-/PR-/HER2- or ER-/PR-/HER2+. There are considerable differences in survival, demographics, and tumor characteristics among the eight subtypes. We recommend reporting breast cancer as an ER/PR/HER2 subtype and precisely documenting demographic and tumor characteristics.