Jung Hyun Ae, Park Yeon Hee, Kim Moonjin, Kim Sungmin, Chang Won Jin, Choi Moon Ki, Hong Jung Yong, Kim Seok Won, Kil Won Ho, Lee Jeong Eon, Nam Seok Jin, Ahn Jin Seok, Im Young-Hyuck
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
Tumour Biol. 2015 Feb;36(2):1073-9. doi: 10.1007/s13277-014-2730-2. Epub 2014 Oct 19.
Recently, we faced difficult treatment decisions regarding appropriate adjuvant systemic treatment, especially for patients who show discordance between stage and tumor biology. The aim of this study was to compare the prognostic relevance of the TNM staging system with that of intrinsic subtype in breast cancer. We retrospectively identified women patients who received curative surgery for stage I-III breast cancer with available data on immunohistochemistry profiles including hormone receptor (HR) status, human epidermal growth factor receptor 2 (HER2) status, and Ki 67 staining at the Samsung Medical Center from January 2004 to September 2008. Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). A total of 1145 patients were diagnosed with breast cancer and received curative surgery. Of these, 463 (40.4%) patients were stage I, and 682 (59.6%) were stage II or III. In addition, 701 (61.2%) patients were HR positive, 239 (20.9%) were HER2 positive, and 205 (20.9%) had triple-negative breast cancer. The 5-year RFS for the patients who were HR positive and HER2 negative with a low Ki 67 staining score (0-25%) was 99%. The 5-year RFS for patients who were HER2-positive or had triple-negative breast cancer were 89 and 83%, respectively (P value = <0.001). In multivariate analysis, advanced stage (II/III) and unfavorable biology (HER2 positive or triple negative) retained their statistical significance as predictors of decreased RFS and OS. Patients with advanced-stage disease (II or III) but favorable tumor biology (HR positive and HER2 negative and low Ki 67) had better clinical outcomes than those with stage I disease and unfavorable tumor biology in terms of RFS (99 versus 92%, P value = 0.011) and OS (99 versus 96%, P value = 0.03) at 5 years. The current results showed that intrinsic subtype has a greater prognostic impact in predicting clinical outcomes in subpopulations of patients with stage I-III breast cancer who show discordance between stage and biologic subtypes.
最近，我们在确定合适的辅助性全身治疗方案时面临着艰难的抉择，尤其是对于那些分期与肿瘤生物学特征不一致的患者。本研究的目的是比较TNM分期系统与乳腺癌内在亚型在预后方面的相关性。我们回顾性地确定了2004年1月至2008年9月在三星医疗中心接受I-III期乳腺癌根治性手术且有免疫组化数据的女性患者，这些数据包括激素受体（HR）状态、人表皮生长因子受体2（HER2）状态以及Ki-67染色情况。主要观察指标为无复发生存期（RFS）和总生存期（OS）。共有1145例患者被诊断为乳腺癌并接受了根治性手术。其中，463例（40.4%）为I期患者，682例（59.6%）为II期或III期患者。此外，701例（61.2%）患者HR阳性，239例（20.9%）患者HER2阳性，205例（20.9%）为三阴性乳腺癌患者。HR阳性、HER2阴性且Ki-67染色评分低（0-25%）的患者5年RFS为99%。HER2阳性或三阴性乳腺癌患者的5年RFS分别为89%和83%（P值<0.001）。在多变量分析中，晚期（II/III期）和不良生物学特征（HER2阳性或三阴性）作为RFS和OS降低的预测因素仍具有统计学意义。在5年时，晚期疾病（II期或III期）但肿瘤生物学特征良好（HR阳性、HER2阴性且Ki-67低）的患者在RFS（99%对92%，P值=0.011）和OS（99%对96%，P值=0.03）方面的临床结局优于I期疾病且肿瘤生物学特征不良的患者。目前的结果表明，内在亚型在预测I-III期乳腺癌患者中分期与生物学亚型不一致的亚组患者的临床结局方面具有更大的预后影响。
