Tsuda H, Hirohashi S, Shimosato Y, Hirota T, Tsugane S, Watanabe S, Terada M, Yamamoto H
Department of Pathology, National Cancer Center Research Institute, Tokyo, Japan.
Cancer. 1990 Apr 15;65(8):1794-800. doi: 10.1002/1097-0142(19900415)65:8<1794::aid-cncr2820650821>3.0.co;2-y.
A system of histologic grade of malignancy in human breast carcinoma was devised by significantly modifying the way of evaluating number of mitoses and architectural atypia in the histologic grading of Bloom and Richardson. The modified grading system was applicable to all histologic subtypes of adenocarcinoma and showed a good association with prognosis of breast carcinoma patients in retrospective analysis of 176 consecutive surgical cases (P less than 0.0001). Of the three components of histologic grade, architectural atypia and number of mitotic figures independently had a significant effect on the prognosis. The copy number of c-erbB-2, a prognostic factor independent of tumor size and nodal status, was strongly correlated with the histologic grade, number of mitotic figures, and degree of nuclear atypia (P less than 0.001, each). Cox's regression model analysis showed that nodal status and histologic grade were two determinants of prognosis, and the independent effect of c-erbB-2 amplification was absorbed within that of the histologic grade. Although the importance of c-erbB-2 gene copy number seemed to be inferior to that of the histologic grade, both were shown to be strongly associated with the aggressiveness of the tumor itself rather than the extent of tumor spread.
通过显著修改布鲁姆和理查森组织学分级中评估有丝分裂数量和结构异型性的方式，设计了一种人类乳腺癌恶性组织学分级系统。在对176例连续手术病例的回顾性分析中，改良后的分级系统适用于腺癌的所有组织学亚型，并且与乳腺癌患者的预后显示出良好的相关性（P小于0.0001）。在组织学分级的三个组成部分中，结构异型性和有丝分裂象数量对预后有独立的显著影响。c-erbB-2的拷贝数是一个独立于肿瘤大小和淋巴结状态的预后因素，与组织学分级、有丝分裂象数量和核异型程度密切相关（各P小于0.001）。考克斯回归模型分析表明，淋巴结状态和组织学分级是预后的两个决定因素，c-erbB-2扩增的独立作用在组织学分级的作用范围内被吸收。尽管c-erbB-2基因拷贝数的重要性似乎低于组织学分级，但两者均显示与肿瘤本身的侵袭性密切相关，而非肿瘤扩散程度。
