Is There a Low-Grade Precursor Pathway in Breast Cancer?
Is There a Low-Grade Precursor Pathway in Breast Cancer?
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DOI：
10.1245/s10434-011-2053-0
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发表时间：
2012-04-01
影响因子：
3.7
通讯作者：
Morrow, Monica
中科院分区：
文献类型：
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作者：
King, Tari A.;Sakr, Rita A.;Morrow, Monica
背景新提出的乳腺肿瘤发生模型表明，低级别和高级别病变具有不同的肿瘤进展途径。我们的目的是研究小叶原位癌（LCIS）和导管原位癌（DCIS）患者的组织学分级和分子亚型之间的关系，这些患者随后发生同侧浸润性乳腺癌。纳入了接受经典LCIS监测的患者（1994-2007年）和接受乳房肿瘤切除术+/-放射治疗DCIS后随访的患者（1991-2004年），这些患者随后发生了同侧浸润性癌症并有可用的组织块。ER/PR/HER 2替代物用于分子亚型。27例发生同侧浸润性癌的经典LCIS患者（12例浸润性导管癌[IDC]，14例浸润性小叶癌，1例混合癌）和26例发生同侧IDC的DCIS患者（12例低度[LG]，14例高度[HG]）的材料可用。LCIS组和DCIS组之间的诊断年龄或浸润性癌症的中位时间无差异。当按等级分层时，12例LG-DCIS中0例发生LG-IDC（3例II级; 9例III级），12例发生IDC的LCIS患者中仅1例发生LG-IDC。13名（93%）HG-DCIS患者出现HG-IDC。相反，27例LCIS中有23例（85%）和26例DCIS中有18例（69%）保持分子亚型。这些数据不支持以LCIS和LG-DCIS为特征的低级前体途径。ER/PR和HER 2状态在原位和随后的浸润性病变之间具有较高的一致率。需要对异时性原位和浸润性病变进行进一步研究，以更好地了解乳腺肿瘤发生的途径。
Background. Newly proposed models of breast tumorigenesis suggest that low- and high-grade lesions have distinct tumor progression pathways. Our objective was to examine the relationship between histologic grade and molecular subtype in women with lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS) who developed subsequent ipsilateral invasive breast cancers.Methods. Patients who underwent surveillance for classical LCIS (1994-2007) and those followed after lumpectomy +/- radiation for DCIS (1991-2004) who developed subsequent ipsilateral invasive cancers and had available tissue blocks were included. ER/PR/HER2 surrogates were used for molecular subtype.Results. Material was available for 27 patients with classical LCIS who developed ipsilateral invasive cancer (12 invasive ductal cancer [IDC], 14 invasive lobular, 1 mixed), and 26 patients with DCIS (12 low-grade [LG], 14 high-grade [HG]) who developed ipsilateral IDC. No difference in age at diagnosis or median time to invasive cancer existed between groups with LCIS and DCIS. When stratified by grade, 0 of 12 LG-DCIS developed LG-IDC (3 grade II; 9 grade III), and only 1 of 12 LCIS patients who developed IDC had LG-IDC. Thirteen (93%) patients with HG-DCIS developed HG-IDC. In contrast, molecular subtype was maintained in 23 of 27 (85%) cases of LCIS and in 18 of 26 (69%) cases of DCIS.Conclusions. These data do not support a low-grade precursor pathway characterized by LCIS and LG-DCIS. ER/PR and HER2 status have a high rate of concordance between in situ and subsequent invasive lesions. Additional studies of metachronous in situ and invasive lesions are needed to better understand pathways of breast tumorigenesis.