乳腺癌的经典和新型预后标志物及其临床意义。
Classical and Novel Prognostic Markers for Breast Cancer and their Clinical Significance.
机构信息
The Departments of Pathology and.
出版信息
Clin Med Insights Oncol. 2010 Apr 20;4:15-34. doi: 10.4137/cmo.s4773.
The use of biomarkers ensures breast cancer patients receive optimal treatment. Established biomarkers such as estrogen receptor (ER) and progesterone receptor (PR) have been playing significant roles in the selection and management of patients for endocrine therapy. HER2 is a strong predictor of response to trastuzumab. Recently, the roles of ER as a negative and HER2 as a positive indicator for chemotherapy have been established. Ki67 has traditionally been recognized as a poor prognostic factor, but recent studies suggest that measurement of Ki67-positive cells during treatment will more effectively predict treatment efficacy for both anti-hormonal and chemotherapy. p53 mutations are found in 20-35% of human breast cancers and are associated with aggressive disease with poor clinical outcome when the DNA-binding domain is mutated. The utility of cyclin D1 as a predictor of breast cancer prognosis is controversial, but cyclin D1b overexpression is associated with poor prognosis. Likewise, overexpression of the low molecular weight form of cyclin E1 protein predicts poor prognosis. Breast cancers from BRCA1/2 carriers often show high nuclear grades, negativity to ER/PR/HER2, and p53 mutations, and thus, are associated with poor prognosis. The prognostic values of other molecular markers, such as p14(ARF), TBX2/3, VEGF in breast cancer are also discussed. Careful evaluation of these biomarkers with current treatment modality is required to determine whether their measurement or monitoring offer significant clinical benefits.
生物标志物的应用可确保乳腺癌患者获得最佳治疗。已确立的生物标志物,如雌激素受体 (ER) 和孕激素受体 (PR),在选择和管理内分泌治疗患者方面发挥着重要作用。HER2 是曲妥珠单抗反应的强预测因子。最近,ER 作为化疗阴性和 HER2 作为化疗阳性指标的作用已经确立。Ki67 传统上被认为是预后不良的因素,但最近的研究表明,在治疗过程中测量 Ki67 阳性细胞将更有效地预测抗激素和化疗的治疗效果。在 20-35%的人类乳腺癌中发现了 p53 突变,并且当 DNA 结合域发生突变时,与侵袭性疾病和不良临床结局相关。细胞周期蛋白 D1 作为乳腺癌预后预测因子的作用存在争议,但细胞周期蛋白 D1b 的过表达与预后不良相关。同样,细胞周期蛋白 E1 蛋白低分子量形式的过表达预示着预后不良。BRCA1/2 携带者的乳腺癌通常显示核分级高、ER/PR/HER2 阴性和 p53 突变,因此与预后不良相关。其他分子标志物的预后价值,如 p14(ARF)、TBX2/3、VEGF 在乳腺癌中的作用也进行了讨论。需要对这些生物标志物与当前治疗方式进行仔细评估,以确定它们的测量或监测是否提供显著的临床益处。
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