Molecular Oncology Department, Centre de Recherche en Cancérologie de Marseille, UMR891 Inserm, Institut Paoli-Calmettes, Marseille, France.
Eur J Cancer. 2011 Jul;47(10):1537-45. doi: 10.1016/j.ejca.2011.02.002. Epub 2011 Mar 8.
Triple-negative breast cancers (TNBC) have the worst outcome of all breast cancer subtypes. Nevertheless TNBC are heterogeneous in terms of pathological, biological and prognostic behaviours. We explored clinical and pathological factors correlated with outcome in this phenotype.
We retrospectively studied clinical and pathological factors correlated with prognosis in a series of 344 early TNBC. Staining for blood (CD31) and lymphatic (Podoplanin) vascular endothelium markers was performed to best characterise peritumoural vascular invasion (PVI) in 108 cases available for pathological reviewing.
Univariate and multivariate analyses performed on our whole cohort underlined PVI as an independent predictive factor of distant metastasis (p=0.00012, HR=2.72 [1.63-4.52]). Standardised pathological reviewing of 101 histologically confirmed TNBC showed that PVI, observed in 41% (28% by haematoxylin and eosin staining plus 13% by immunohistochemistry), was confirmed as the first prognostic factor in TNBC, particularly in node-negative tumours. Five-year metastasis-free survival in this subset was 87.5% and 50.8% without and with PVI, respectively (p=0.003).
Vascular invasion diagnosis is improved by the combination of HES and IHC. Moreover it is a major prognostic feature and must take a greater part in therapeutic management of early TNBC with the possibility to adapt the adjuvant treatment according to the predicted relapse risk.
三阴性乳腺癌（TNBC）是所有乳腺癌亚型中预后最差的。然而，TNBC 在病理、生物学和预后行为方面存在异质性。我们探讨了与这种表型相关的临床和病理因素与结局的关系。
我们回顾性研究了 344 例早期 TNBC 中与预后相关的临床和病理因素。在 108 例可进行病理复查的病例中，对肿瘤周围血管（CD31 和 Podoplanin）进行染色，以最佳描述肿瘤周围血管侵犯（PVI）。
对我们整个队列进行单因素和多因素分析，强调 PVI 是远处转移的独立预测因素（p=0.00012，HR=2.72[1.63-4.52]）。对 101 例经组织学证实的 TNBC 进行标准化病理复查显示，PVI（41%，其中 28%为苏木精和伊红染色阳性，13%为免疫组化阳性）是 TNBC 的第一个预后因素，特别是在淋巴结阴性的肿瘤中。在这一组中，无 PVI 和有 PVI 的患者 5 年无转移生存率分别为 87.5%和 50.8%（p=0.003）。
HES 和 IHC 的联合应用可提高血管侵犯的诊断。此外，它是一个主要的预后特征，必须在早期 TNBC 的治疗管理中占据更大的比重，根据预测的复发风险，有可能调整辅助治疗。
