Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul 135-710, Korea.
Breast Cancer Res Treat. 2012 May;133(1):247-55. doi: 10.1007/s10549-012-1956-1. Epub 2012 Jan 21.
The aims of the study were to identify a subpopulation more likely to be at greater risk of recurrence in small T1b-c node-negative hormone receptor (HR)-positive breast cancer, and which would benefit from adjuvant chemotherapy. Clinico-pathologic characteristics and clinical outcomes of 538 postoperative HR-positive T1b-cN0 breast cancer patients were retrospectively analyzed. High Ki67 index and a young age (< 35 years) were identified as independent risk factors for relapse (p < 0.0001 and 0.015, respectively). A nomogram based on Cox-regression model showed an area under the curve (AUC) of 0.73 in the training set. The validation set showed a good discrimination with an AUC of 0.65. In patients with high nomogram scores (≥ 100, n = 24, 4.5%) who had high Ki67 index with more than 75%, or young age (< 35 years) and a Ki67 index > 50%, the relapse-free survival curve of patients who had received anthracycline-containing adjuvant chemotherapy showed a better outcome than those who had not (p = 0.029). Ki67 index and age are valuable surrogate markers to predict recurrence and as indicators of tumors that could benefit from adjuvant chemotherapy in small T1b-c node-negative HR-positive breast cancer.
本研究旨在确定 HR 阳性、T1b-cN0 期、淋巴结阴性、小肿瘤（T1b-c）的乳腺癌患者中，更有可能存在复发高风险的亚组人群，并为辅助化疗的获益提供预测。本研究回顾性分析了 538 例 HR 阳性、T1b-cN0 期乳腺癌患者的临床病理特征和临床结局。高 Ki67 指数和年轻（<35 岁）被确定为复发的独立危险因素（p<0.0001 和 0.015）。基于 Cox 回归模型的列线图在训练集中的 AUC 为 0.73。验证集中的 AUC 为 0.65，具有良好的判别能力。在高列线图评分（≥100，n=24，4.5%）的患者中，Ki67 指数>75%或年轻（<35 岁）且 Ki67 指数>50%，接受含蒽环类药物辅助化疗的患者无复发生存曲线优于未接受化疗的患者（p=0.029）。Ki67 指数和年龄是预测复发的有价值的替代标志物，也是小 T1b-c 期、淋巴结阴性、HR 阳性乳腺癌中可从辅助化疗中获益的肿瘤标志物。
