Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 215-4 Gongneung-dong, Nowon-gu, 139-706 Seoul, Republic of Korea.
Eur J Surg Oncol. 2011 Jul;37(7):629-34. doi: 10.1016/j.ejso.2011.04.014. Epub 2011 May 19.
Gene expression profiling studies have identified several breast cancer subtypes associated with markedly different clinical outcomes. In general, patients with stage I breast cancer have excellent outcomes. We assessed the clinicopathological characteristics and outcomes of patients with T1N0M0 breast cancer according to molecular subtype.
Seven hundred and sixty-two T1N0M0 breast cancer patients undergoing curative surgery between January 1990 and December 2007 were analyzed. Subtypes were classified according to hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status as follows: HR+/HER2-, HR+/HER2+, HR-/HER2- (triple-negative, TN), and HR-/HER2+.
The distribution of subtypes was HR+/HER2-, 56.6%; HR+/HER2+, 10.1%; TN, 20.1%; and HR-/HER2+, 13.3%. Marked differences were observed among subtypes in multifocality/multicentricity, histological grade, extensive intraductal components, p53 expression and the Ki-67 index. There were differences in recurrence-free survival and overall survival among patients with different molecular subtypes (log-rank p < 0.001 and 0.024, respectively). By multivariate analysis, lymphovascular invasion and classification of molecular subtype were independent predictors of recurrence (p = 0.003 and 0.043, respectively). The TN subtype showed significantly worse recurrence-free survival compared to the HR+/HER2- subtype (hazard ratio, 4.54; 95% confidence interval, 1.60-12.86; p = 0.004).
Patients with T1N0M0 breast cancer, a group with generally favorable clinical outcomes, had prognoses that were associated with the molecular subtype. The TN subtype was an independent predictor for recurrence in patients with T1N0M0 breast cancer.
基因表达谱研究已经确定了几种与明显不同临床结果相关的乳腺癌亚型。一般来说，I 期乳腺癌患者的预后非常好。我们根据分子亚型评估了 T1N0M0 乳腺癌患者的临床病理特征和结局。
分析了 1990 年 1 月至 2007 年 12 月期间接受根治性手术的 762 例 T1N0M0 乳腺癌患者。根据激素受体（HR）和人表皮生长因子受体-2（HER2）状态将亚型分类为 HR+/HER2-、HR+/HER2+、HR-/HER2-（三阴性，TN）和 HR-/HER2+。
亚型分布为 HR+/HER2-，56.6%；HR+/HER2+，10.1%；TN，20.1%；HR-/HER2+，13.3%。在多灶性/多中心性、组织学分级、广泛的导管内成分、p53 表达和 Ki-67 指数方面，各亚型之间存在显著差异。不同分子亚型患者的无复发生存率和总生存率存在差异（对数秩检验 p<0.001 和 0.024）。多变量分析显示，脉管侵犯和分子亚型分类是复发的独立预测因素（p=0.003 和 0.043）。TN 亚型与 HR+/HER2-亚型相比，无复发生存率显著更差（风险比，4.54；95%置信区间，1.60-12.86；p=0.004）。
T1N0M0 乳腺癌患者总体临床结局良好，其预后与分子亚型相关。TN 亚型是 T1N0M0 乳腺癌患者复发的独立预测因素。
