Lee Su Hyun, Kim Young-Seon, Han Wonshik, Ryu Han Suk, Chang Jung Min, Cho Nariya, Moon Woo Kyung
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul Department of Radiology, Yeungnam University Medical Center, Daegu Department of Surgery Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. .
Medicine (Baltimore). 2016 Sep;95(37):e4874. doi: 10.1097/MD.0000000000004874.
Several studies suggest that delay in the surgical treatment of breast cancer is significantly associated with lower survival. This study evaluated the tumor growth rate (TGR) of invasive breast cancers during wait times for surgery quantitatively using ultrasonography (US) and identified clinicopathologic factors associated with TGR.This retrospective study was approved by our institutional review board and the requirement for written informed consent was waived. Between August 2013 and September 2014, a total of 323 unifocal invasive breast cancers in 323 women with serial US images at the time of diagnosis and surgery were included. Tumor diameters and volumes were measured using 2-orthogonal US images. TGR during wait times for surgery was quantified as specific growth rates (SGR; %/day) and was compared with clinicopathologic variables using univariate and multivariate analyses.Median time from diagnosis to surgery was 31 days (range, 8-78 days). Maximum tumor diameters and volumes at the time of surgery (mean, 15.6 mm and 1.6 cm) were significantly larger than at diagnosis (14.7 mm and 1.3 cm) (P < 0.001). On multivariate analysis, surrogate molecular subtype was a significant independent factor of SGR (P = 0.001); triple negative cancers showed the highest SGR (1.003%/day) followed by HER2-positive (0.859 %/day) and luminal cancers (luminal B, 0.208 %/day; luminal A, 0.175%/day) (P < 0.001). Clinical T stage was more frequently upgraded in nonluminal (triple negative, 18% [12/67]; HER2-positive, 14% [3/22]) than luminal cancers (luminal B, 3% [1/30]; luminal A, 2% [4/204]) (P < 0.001).Invasive breast cancers with aggressive molecular subtypes showed faster TGR and more frequent upgrading of clinical T stage during wait times for surgery.
多项研究表明，乳腺癌手术治疗的延迟与较低的生存率显著相关。本研究使用超声（US）定量评估了浸润性乳腺癌在等待手术期间的肿瘤生长率（TGR），并确定了与TGR相关的临床病理因素。本回顾性研究经机构审查委员会批准，且豁免了书面知情同意的要求。2013年8月至2014年9月，纳入了323例单灶浸润性乳腺癌患者，这些患者在诊断和手术时均有系列超声图像。使用2张正交超声图像测量肿瘤直径和体积。将手术等待期间的TGR量化为特定生长率（SGR；%/天），并使用单变量和多变量分析将其与临床病理变量进行比较。从诊断到手术的中位时间为31天（范围8 - 78天）。手术时的最大肿瘤直径和体积（平均分别为15.6毫米和1.6厘米）显著大于诊断时（14.7毫米和1.3厘米）（P < 0.001）。多变量分析显示，替代分子亚型是SGR的显著独立因素（P = 0.001）；三阴性癌症的SGR最高（1.003%/天），其次是HER2阳性（0.859%/天）和管腔型癌症（管腔B型，0.208%/天；管腔A型，0.175%/天）（P < 0.001）。非管腔型癌症（三阴性，18%[12/67]；HER2阳性，14%[3/22]）的临床T分期比管腔型癌症（管腔B型，3%[1/30]；管腔A型，2%[4/204]）更频繁地升级（P < 0.001）。具有侵袭性分子亚型的浸润性乳腺癌在等待手术期间显示出更快的TGR和更频繁的临床T分期升级。
