School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Department of Oncology, Nottingham University Hospitals, Nottingham, United Kingdom.
PLoS One. 2014 Jul 7;9(7):e100573. doi: 10.1371/journal.pone.0100573. eCollection 2014.
Triple negative (ER, PgR and HER2 negative) breast cancers (TNBCs) are often considered as a poor prognostic phenotype. There is dearth of evidence showing the prevalence and biological behaviour of TNBCs in older women. This study aimed to analyse their biological characteristics in comparison with a well characterised younger series from a single centre with long term clinical follow-up. Over 37 years (1973-2010), 1,758 older (≥70 years) women with early operable (<5 cm) primary breast cancer were managed in a dedicated clinic and have complete clinical information available. Of these 813 patients underwent primary surgery and 575 had good quality tumour samples available for tissue microarray analysis using indirect immunohistochemistry. A total of 127 patients (22.1%) had TNBCs and full biological analysis of 15 biomarkers was performed. The results were compared with those of their younger (<70 years) counterparts 342 (18.9%) from a previously characterised, consecutive series of primary breast cancer treated in the same unit (1986-1998). The 127 older patients with TNBCs showed lower rates of Ki67 and CK 7/8 positivity and high rates of bcl2 and CK18 positivity when compared with their younger counterparts (p<0.05). There was no significant difference in the long term clinical outcome between the two age groups, despite the fact that 47% of the younger patients had adjuvant chemotherapy, while none in the older cohort received such treatment. EGFR, axillary stage and pathological size showed prognostic significance in older women with TNBCs on univariate analysis. Despite not having received adjuvant chemotherapy, the older series had clinical outcome similar to the younger patients almost half of whom had chemotherapy. This appears to be related to other biomarkers (in addition to ER/PgR/HER2) eg Ki67, bcl2 and cytokeratins which have different expression patterns influencing prognosis.
三阴性（雌激素受体、孕激素受体和人表皮生长因子受体 2 均阴性）乳腺癌（TNBC）通常被认为是预后不良的表型。目前缺乏证据表明 TNBC 在老年女性中的流行情况和生物学行为。本研究旨在分析与来自单一中心、长期临床随访的特征明确的年轻系列相比，它们的生物学特征。在 37 年（1973-2010 年）期间，在专门的诊所中对 1758 名年龄较大（≥70 岁）、患有早期可手术（<5cm）原发性乳腺癌的老年女性进行了管理，并且这些患者具有完整的临床信息。其中 813 例患者接受了原发性手术，575 例患者有高质量的肿瘤样本可用于间接免疫组织化学的组织微阵列分析。共有 127 例患者（22.1%）患有 TNBC，并对 15 种生物标志物进行了全面的生物学分析。将这些结果与之前特征明确的、在同一单位（1986-1998 年）治疗的连续原发性乳腺癌系列中的年轻患者（<70 岁）342 例（18.9%）的结果进行比较。与年轻患者（Ki67 和 CK7/8 阳性率较低，bcl2 和 CK18 阳性率较高（p<0.05）。尽管年轻患者中有 47%接受了辅助化疗，而年长患者中没有人接受这种治疗，但两组的长期临床结果没有显著差异。在单因素分析中，EGFR、腋窝分期和病理大小在年长的 TNBC 女性中具有预后意义。尽管没有接受辅助化疗，但年长组的临床结果与年轻患者相似，其中近一半的患者接受了化疗。这似乎与其他生物标志物（除了 ER/PgR/HER2 之外）有关，例如 Ki67、bcl2 和细胞角蛋白，它们具有不同的表达模式，影响预后。
