Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway.
Breast Cancer Res Treat. 2011 Jul;128(1):137-46. doi: 10.1007/s10549-011-1487-1. Epub 2011 Apr 8.
The purpose of this article is to investigate the prognostic value of the mitotic activity index (MAI) and the presence of disseminated tumor cells (DTCs) in bone marrow (BM), in clinically operable breast cancer patients. We compared routinely assessed MAI, classic prognosticators and BM DTCs, detected by a real-time RT-PCR multimarker assay including cytokeratin 19, mammaglobin A and TWIST1 mRNA, in 179 consecutive patients with operable breast cancer. Over a median follow-up of 96 months (range: 1-126 months), 31 (17.3%) patients experienced a systemic relapse and 26 (14.5%) died of breast cancer-related causes. MAI (≥ 10) was strongly associated with breast cancer-related death in lymph node (LN)-negative patients (hazard ratio (HR): 7.0, confidence interval (CI) 1.74-27.9), whereas both BM DTC-status (HR: 3.3, CI 1.25-8.52) and MAI (HR: 3.1, CI 1.08-8.8) were significant in LN-positive patients. With multivariate Cox regression, MAI was the only significant predictor of breast cancer-specific survival (HR 7.0, CI 1.7-27.9) in LN-negative patients. In LN-positive patients, both BM DTC-status and MAI were strong independent predictors of breast cancer-specific survival (HR 3.3, CI 1.25-8.49 and HR 3.1, CI 1.1-8.9), respectively. Where, however, MAI and BM DTC-status as single parameters were replaced by a combination of these, this showed to be the most significant prognostic marker in both LN-negative (HR 7.7, CI 1.2-50) and LN-positive (HR 6.0, CI 1.4 to 26.4) patients with regard to breast cancer-specific survival. A combination of MAI and BM DTC detection identified both LN-negative and LN-positive breast cancer patients with poor prognosis.
本文旨在探讨有丝分裂活性指数（MAI）和骨髓（BM）中播散性肿瘤细胞（DTC）在临床可手术乳腺癌患者中的预后价值。我们比较了 179 例连续可手术乳腺癌患者常规评估的 MAI、经典预后因素和通过实时 RT-PCR 多标志物检测到的 BM DTCs，该检测包括细胞角蛋白 19、乳球蛋白 A 和 TWIST1mRNA。在中位随访 96 个月（范围：1-126 个月）期间，31 例（17.3%）患者出现全身复发，26 例（14.5%）死于乳腺癌相关原因。在淋巴结（LN）阴性患者中，MAI（≥10）与乳腺癌相关死亡密切相关（风险比（HR）：7.0，置信区间（CI）1.74-27.9），而 BM DTC 状态（HR：3.3，CI 1.25-8.52）和 MAI（HR：3.1，CI 1.08-8.8）在 LN 阳性患者中均有显著意义。多变量 Cox 回归分析显示，在 LN 阴性患者中，MAI 是乳腺癌特异性生存的唯一显著预测因子（HR 7.0，CI 1.7-27.9）。在 LN 阳性患者中，BM DTC 状态和 MAI 均为乳腺癌特异性生存的独立强预测因子（HR 3.3，CI 1.25-8.49 和 HR 3.1，CI 1.1-8.9）。然而，当将 MAI 和 BM DTC 状态作为单个参数替换为这些参数的组合时，在 LN 阴性（HR 7.7，CI 1.2-50）和 LN 阳性（HR 6.0，CI 1.4-26.4）患者中，这显示出对乳腺癌特异性生存的最显著预后标志物。MAI 和 BM DTC 检测的组合可识别出预后不良的 LN 阴性和 LN 阳性乳腺癌患者。
