Li Jianyi, Jia Shi, Zhang Wenhai, Zhang Yang, Fei Xiang, Tian Rui
Department of Breast Surgery, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, Liaoning 110004, China.
ISRN Oncol. 2013 Jul 30;2013:606398. doi: 10.1155/2013/606398. eCollection 2013.
Background. Immunohistochemical markers were often used to classify breast cancer into subtypes. The aim of this study was to estimate death and tumor progression for patients with the major subtypes of breast cancer as classified using immunohistochemical assay and to investigate the patterns of benefit from the therapies over the past years. Methods. The study population included primary, operable 199 invasive ductal breast cancer patients, with the median age of 51.1 years old. All patients underwent local and/or systemic treatments. The clinicopathological characteristics and clinical outcomes were retrospectively reviewed. The expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67 was analyzed by immunohistochemistry. All patients were classified into the following categories: luminal A, luminal B, HER2 overexpression, and triple-negative subtypes. Result. The median follow-up time was 33 months. Luminal A tumors had the lowest rate of tumor progression (0%, P = 0.006), while luminal B, HER2 over-expression, and triple-negative subtypes were associated with an increased risk of tumor progression (15.4, 19.2, 15.4%). Clinicopathological subtypes retained independent prognostic significance (P = 0.008). There were significant differences by Cox model analyzed in age, menopause, lymph node metastasis, and HER2 for the event of death and tumor progression (P < 0.05), and there were significant differences only in chemotherapy for the event, respectively (P < 0.05). Conclusion. Clinicopathological subtypes of breast cancer could robustly identify the risk of death and tumor progression and were significant in making therapeutic decision. HER2 was the important poor indicator. The chemotherapy intensity would be enhanced for patients with luminal B, especially for HER2 over-expression subgroup.
背景。免疫组织化学标志物常被用于将乳腺癌分为不同亚型。本研究的目的是评估使用免疫组织化学检测方法分类的主要乳腺癌亚型患者的死亡和肿瘤进展情况，并调查过去几年中治疗获益模式。方法。研究人群包括199例原发性、可手术的浸润性导管癌患者，中位年龄为51.1岁。所有患者均接受了局部和/或全身治疗。对临床病理特征和临床结局进行回顾性分析。通过免疫组织化学分析雌激素受体、孕激素受体、人表皮生长因子受体2和Ki67的表达。所有患者被分为以下几类：腔面A型、腔面B型、HER2过表达型和三阴性亚型。结果。中位随访时间为33个月。腔面A型肿瘤的肿瘤进展率最低（0%，P = 0.006），而腔面B型、HER2过表达型和三阴性亚型与肿瘤进展风险增加相关（15.4%、19.2%、15.4%）。临床病理亚型具有独立的预后意义（P = 0.008）。通过Cox模型分析，年龄、绝经状态、淋巴结转移和HER2在死亡和肿瘤进展事件方面存在显著差异（P < 0.05），且在化疗事件方面也分别存在显著差异（P < 0.05）。结论。乳腺癌的临床病理亚型能够可靠地识别死亡和肿瘤进展风险，对治疗决策具有重要意义。HER2是重要的不良指标。对于腔面B型患者，尤其是HER2过表达亚组患者，应加强化疗强度。
