Department of General Surgery II, University Hospital ASST Spedali Civili, Brescia, Italy.
Department of Radiation Oncology, University Hospital ASST Spedali Civili, Brescia, Italy.
J Surg Res. 2019 Apr;236:288-299. doi: 10.1016/j.jss.2018.11.028. Epub 2018 Dec 27.
Molecular subtype predicts the prognosis of early-stage breast cancer patients. We assessed the long-term outcomes of breast cancer ≤2 cm treated with breast-conserving surgery (BCS) and stratified according to an immunohistochemically (IHC)-based subtype definition.
This retrospective study was conducted from a prospectively collected database. Included patients had pT1, any N, M0 breast cancer after BCS (without anti-HER2 therapy) and available information on estrogen receptor (ER), progesterone receptor (PR), HER2 status, Ki-67 index. Five IHC-defined subtypes were identified: luminal A-like (ER and/or PR-positive/HER2-negative/Ki-67 < 20%), luminal B-like/HER2-negative (ER and/or PR-positive/HER2-negative/Ki-67 ≥ 20%), luminal B-like/HER2-positive (ER and/or PR-positive/HER2-positive/any Ki-67 value), HER2-positive/nonluminal (ER and PR-negative/HER2-positive), and triple-negative (ER and PR-negative/HER2-negative).
We analyzed 184 (65%) luminal A-like, 57 (20%) luminal B-like/HER2-negative, 17 (6%) luminal B-like/HER2-positive, 6 (2%) HER2-positive/nonluminal, and 18 (7%) triple-negative patients. Median follow-up was 112 (interquartile range 94-125) mo. The cumulative 5- and 10-y local recurrence (LR) rates were 1.5% and 4%, respectively. The cumulative 5- and 10-y distant recurrence (DR) rates were 3% and 8%, respectively. The Cox regression revealed that HER2-positive/nonluminal subtypes had the highest risk of LR (P = 0.0025). The luminal B-like/HER2-positive subtypes had the highest risk of DR (P = 0.0019). HER2 positivity carried a higher risk of DR in women with luminal breast cancer who completed 5 y of adjuvant hormonal therapy (P = 0.02).
The IHC-defined subtype impacts on the prognosis of breast cancer ≤2 cm after BCS, determining significant differences in LR and DR rates. In the pre-"anti-HER2 therapy" era, patients with HER2-positive/nonluminal or luminal B-like/HER2-positive subtype had worse long-term outcomes than those with luminal A-like subtype.
分子亚型可预测早期乳腺癌患者的预后。我们评估了接受保乳手术（BCS）治疗的≤2cm 乳腺癌患者的长期结局，并根据免疫组织化学（IHC）定义的亚型进行分层。
这是一项从前瞻性收集的数据库中进行的回顾性研究。纳入的患者为 pT1、任何 N、M0 期乳腺癌，在接受 BCS 后（无抗 HER2 治疗），并具有雌激素受体（ER）、孕激素受体（PR）、HER2 状态和 Ki-67 指数的信息。确定了 5 种 IHC 定义的亚型：管腔 A 样（ER 和/或 PR 阳性/HER2 阴性/Ki-67<20%）、管腔 B 样/HER2 阴性（ER 和/或 PR 阳性/HER2 阴性/Ki-67≥20%）、管腔 B 样/HER2 阳性（ER 和/或 PR 阳性/HER2 阳性/任何 Ki-67 值）、HER2 阳性/非管腔（ER 和 PR 阴性/HER2 阳性）和三阴性（ER 和 PR 阴性/HER2 阴性）。
我们分析了 184 例（65%）管腔 A 样、57 例（20%）管腔 B 样/HER2 阴性、17 例（6%）管腔 B 样/HER2 阳性、6 例（2%）HER2 阳性/非管腔和 18 例（7%）三阴性患者。中位随访时间为 112（四分位距 94-125）个月。累积 5 年和 10 年局部复发（LR）率分别为 1.5%和 4%。累积 5 年和 10 年远处复发（DR）率分别为 3%和 8%。Cox 回归显示 HER2 阳性/非管腔亚型具有最高的 LR 风险（P=0.0025）。管腔 B 样/HER2 阳性亚型具有最高的 DR 风险（P=0.0019）。在接受 5 年辅助激素治疗的 luminal 乳腺癌患者中，HER2 阳性与 DR 风险增加相关（P=0.02）。
IHC 定义的亚型影响 BCS 后≤2cm 乳腺癌的预后，决定了 LR 和 DR 率的显著差异。在“抗 HER2 治疗”前时代，HER2 阳性/非管腔或管腔 B 样/HER2 阳性亚型患者的长期结局较管腔 A 样亚型患者差。
