Surgery, School of Medicine, National University of Ireland, Galway, Ireland.
Breast Cancer Res Treat. 2012 Jun;133(3):831-41. doi: 10.1007/s10549-011-1891-6. Epub 2011 Dec 7.
Molecular subtyping confirms that breast cancer comprises at least four genetically distinct entities based on the expression of specific genes including estrogen receptor (ER), progesterone receptor (PR), and HER2/neu receptor. The quantitative influence of subtype on ipsilateral locoregional recurrence (LRR) is unknown. The aim of this study was to systematically appraise the influence of breast cancer subtype on LRR following breast conserving therapy (BCT) and mastectomy. A comprehensive search for studies examining outcomes after BCT and/or mastectomy according to breast cancer subtype was performed using Medline and cross-referencing available data. Reviews of each study were conducted and data extracted to perform meta-analysis. Primary outcome was LRR related to breast cancer subtype. A total of 12,592 breast cancer patients who underwent either BCT (n = 7,174) or mastectomy (n = 5,418) were identified from 15 studies. Patients with luminal subtype tumors (ER/PR +ve) had a lower risk of LRR than both triple-negative (RR 0.38; 95% CI 0.23-0.61); and HER2/neu-overexpressing (RR 0.34; 95% CI 0.26-0.45) tumors following BCT. Luminal tumors were also less likely to develop LRR than HER2/neu-overexpressing (OR 0.69; 95% CI 0.54-0.89) or triple-negative tumors (OR 0.61; 95% CI 0.46-0.79) after mastectomy. HER2/neu-overexpressing tumors have increased risk of LRR compared to triple-negative tumors (RR 1.44; 95% CI 1.06-1.95) following BCT but there was no difference in LRR between HER2/neu-overexpressing and triple-negative tumors following mastectomy (RR 0.91; 95% CI 0.68-1.22). Luminal tumors exhibit the lowest rates of LRR. Patients with triple-negative and HER2/neu-overexpressing breast tumors are at increased risk of developing LRR following BCT or mastectomy. Breast cancer subtype should be taken into account when considering local control and identifies those at increased risk of LRR, who may benefit from more aggressive local treatment.
分子亚型证实，乳腺癌至少包含 4 种基于特定基因表达的遗传上不同的实体，包括雌激素受体（ER）、孕激素受体（PR）和 HER2/neu 受体。亚组对同侧局部区域复发（LRR）的定量影响尚不清楚。本研究的目的是系统评估乳腺癌亚型对保乳治疗（BCT）和乳房切除术治疗后 LRR 的影响。使用 Medline 对根据乳腺癌亚型进行 BCT 和/或乳房切除术治疗后结局的研究进行了全面检索，并交叉参考了现有数据。对每项研究进行了综述，并提取数据进行荟萃分析。主要结局为与乳腺癌亚型相关的 LRR。从 15 项研究中确定了 12592 名接受 BCT（n=7174）或乳房切除术（n=5418）治疗的乳腺癌患者。与三阴性（RR 0.38；95%CI 0.23-0.61）和 HER2/neu 过表达（RR 0.34；95%CI 0.26-0.45）肿瘤相比，luminal 亚型肿瘤（ER/PR+ve）患者的 LRR 风险较低。与 HER2/neu 过表达（OR 0.69；95%CI 0.54-0.89）或三阴性（OR 0.61；95%CI 0.46-0.79）肿瘤相比，luminal 肿瘤在接受乳房切除术治疗后发生 LRR 的可能性也较低。与三阴性肿瘤（RR 1.44；95%CI 1.06-1.95）相比，HER2/neu 过表达肿瘤在接受 BCT 后发生 LRR 的风险增加，但在接受乳房切除术治疗后，HER2/neu 过表达肿瘤与三阴性肿瘤之间的 LRR 无差异（RR 0.91；95%CI 0.68-1.22）。luminal 肿瘤的 LRR 发生率最低。接受 BCT 或乳房切除术治疗的三阴性和 HER2/neu 过表达乳腺癌患者发生 LRR 的风险增加。在考虑局部控制时应考虑乳腺癌亚型，并确定那些 LRR 风险增加的患者，他们可能受益于更积极的局部治疗。
