Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Cancer. 2012 Nov 15;118(22):5463-72. doi: 10.1002/cncr.27581. Epub 2012 Apr 27.
The objective of this study was to describe clinicopathologic features, patterns of recurrence, and survival according to breast cancer subtype with a focus on triple-negative tumors.
In total, 15,204 women were evaluated who presented to National Comprehensive Cancer Network centers with stage I through III breast cancer between January 2000 and December 2006. Tumors were classified as positive for estrogen receptor (ER) and/or progesterone receptor (PR) (hormone receptor [HR]-positive) and negative for human epidermal growth factor receptor 2 (HER2); positive for HER2 and any ER or PR status (HER2-positive); or negative for ER, PR, and HER2 (triple-negative).
Subtype distribution was triple-negative in 17% of women (n = 2569), HER2-positive in 17% of women (n = 2602), and HR-positive/HER2-negative in 66% of women (n = 10,033). The triple-negative subtype was more frequent in African Americans compared with Caucasians (adjusted odds ratio, 1.98; P < .0001). Premenopausal women, but not postmenopausal women, with high body mass index had an increased likelihood of having the triple-negative subtype (P = .02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs 48%; P < .0001) and were more likely to present with higher tumor classification, but they were less likely to have lymph node involvement. Relative to HR-positive/HER2-negative tumors, triple-negative tumors were associated with a greater risk of brain or lung metastases; and women with triple-negative tumors had worse breast cancer-specific and overall survival, even after adjusting for age, disease stage, race, tumor grade, and receipt of adjuvant chemotherapy (overall survival: adjusted hazard ratio, 2.72; 95% confidence interval, 2.39-3.10; P < .0001). The difference in the risk of death by subtype was most dramatic within the first 2 years after diagnosis (overall survival for 0-2 years: OR, 6.10; 95% confidence interval, 4.81-7.74).
Triple-negative tumors were associated with unique risk factors and worse outcomes compared with HR-positive/HER2-negative tumors.
本研究旨在描述乳腺癌亚型的临床病理特征、复发模式和生存情况，重点关注三阴性肿瘤。
共纳入 15204 例 2000 年 1 月至 2006 年 12 月在国家癌症综合网络中心就诊的 I 期至 III 期乳腺癌患者。肿瘤被分为雌激素受体（ER）和/或孕激素受体（PR）阳性（激素受体[HR]阳性）和人表皮生长因子受体 2（HER2）阴性；HER2 阳性且任何 ER 或 PR 状态阳性（HER2 阳性）；或 ER、PR 和 HER2 均阴性（三阴性）。
三阴性亚型在 17%的女性（n=2569）中，HER2 阳性在 17%的女性（n=2602）中，HR 阳性/HER2 阴性在 66%的女性（n=10033）中。与白人相比，非洲裔美国人中三阴性亚型更为常见（调整优势比，1.98；P<.0001）。绝经前女性，但不是绝经后女性，高体重指数与三阴性亚型的发生几率增加有关（P=0.02）。患有三阴性癌症的女性不太可能因异常筛查性乳房 X 光检查而就诊（29%比 48%；P<.0001），但更可能表现为更高的肿瘤分级，但淋巴结受累的可能性较低。与 HR 阳性/HER2 阴性肿瘤相比，三阴性肿瘤与脑或肺转移的风险更高；并且即使在调整了年龄、疾病分期、种族、肿瘤分级和辅助化疗的接受情况后，三阴性肿瘤患者的乳腺癌特异性生存和总生存情况也更差（总生存：调整后的危险比，2.72；95%置信区间，2.39-3.10；P<.0001）。在诊断后 2 年内，各亚型的死亡风险差异最为显著（0-2 年总生存率：OR，6.10；95%置信区间，4.81-7.74）。
与 HR 阳性/HER2 阴性肿瘤相比，三阴性肿瘤与独特的危险因素和更差的预后相关。
