Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
Clin Transl Oncol. 2017 Oct;19(10):1232-1240. doi: 10.1007/s12094-017-1660-z. Epub 2017 Apr 13.
Stage shift is considered a major reason for more favorable outcomes in patients with screen-detected breast cancer. However, even after adjusting for clinical stage, unresolved issues concerning the reasons for a survival benefit associated with screening programs remain. This study aims to evaluate differences in subtype distribution and outcomes among patients with screen-detected and symptomatic invasive breast cancer and assess whether variations in subtype distribution could explain differences in prognosis.
Survival analysis was performed to estimate the likelihood of distant recurrence and death in 1132 patients. Subtypes were defined as luminal A [estrogen receptor (ER)+ and/or progesterone receptor (PR)+, human epidermal growth factor receptor 2 (HER2)-, and Ki67 low], luminal B (HER2-) (ER+ and/or PR+, HER2-, and Ki67 high), luminal B (HER2+) (ER+ and/or PR+ and HER2+), HER2 overexpressing (ER-, PR-, and HER2+), and triple negative (ER-, PR-, and HER2-).
Screen-detected cancers had favorable clinicopathological characteristics, such as smaller tumor size and a lower frequency of lymph node involvement. Women with screen-detected cancers had a survival advantage. Subtype distribution differed significantly among women with screen-detected and symptomatic cancer. Screen-detected cancers were more likely to be luminal A and less likely to be HER2 overexpressing or triple negative cancer compared with symptomatic cancers (luminal A 61.3 vs. 44.2%, HER2 overexpressing 4.0 vs. 8.0%, triple negative 8.0 vs. 15.9%). Node status, mode of detection, and subtype were independent prognostic factors in the multivariate analysis.
Differences in subtype distribution between screen-detected and symptomatic cancer could partially explain differences in outcomes.
分期转移被认为是筛检乳腺癌患者获得更好结果的主要原因。然而，即使在调整了临床分期后，与筛查计划相关的生存获益的原因仍存在未解决的问题。本研究旨在评估筛检性和症状性浸润性乳腺癌患者在亚型分布和结局方面的差异，并评估亚型分布的变化是否可以解释预后的差异。
对 1132 例患者进行生存分析，以估计远处复发和死亡的可能性。亚型定义为 luminal A（雌激素受体 [ER]+和/或孕激素受体 [PR]+、人表皮生长因子受体 2 [HER2]-和 Ki67 低）、luminal B（HER2-）（ER+和/或 PR+、HER2-和 Ki67 高）、luminal B（HER2+）（ER+和/或 PR+和 HER2+）、HER2 过表达（ER-、PR-和 HER2+）和三阴性（ER-、PR-和 HER2-）。
筛检性癌症具有良好的临床病理特征，如肿瘤体积较小和淋巴结受累频率较低。筛检性癌症患者的生存优势明显。筛检性和症状性癌症患者的亚型分布差异显著。与症状性癌症相比，筛检性癌症更有可能是 luminal A 型，而不太可能是 HER2 过表达或三阴性癌症（luminal A 为 61.3% vs. 44.2%，HER2 过表达为 4.0% vs. 8.0%，三阴性为 8.0% vs. 15.9%）。淋巴结状态、检出方式和亚型是多变量分析中的独立预后因素。
筛检性和症状性癌症之间的亚型分布差异可以部分解释结局的差异。
