Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China.
Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, 410008, China.
Curr Med Sci. 2019 Jun;39(3):396-402. doi: 10.1007/s11596-019-2049-8. Epub 2019 Jun 17.
This study aimed to examine the prognostic factors of luminal B-like breast cancer. Clinical data of 695 luminal B-like breast cancer patients who had been treated in our hospital during the period of past 4.5 years were collected and analyzed. Estrogen receptor (ER), progesterone receptor (PgR), antigen identified by monoclonal antibody Ki-67 (Ki67) were immunohistochemically detected. Different cutoffs of ER, PgR, and Ki67 were evaluated. Pearson χ test was performed to compare categorical parameters. Univariate and multivariate models were used to evaluate predictors of disease free survival (DFS). The results showed that patients who were younger, and had larger tumors, and more positive lymph nodes were more likely to receive neo-adjuvent chemotherapy (NAC). Patients with ER-positive tumors having <10% positive cells received more anthracycline- and taxane-based chemotherapy and less endocrine therapy than those with ER-positive tumors having ≥10% positive cells (P=0.004 and P=0.007, respectively); however, patients with ER-positive tumors having <10% positive cells experienced more recurrence (P<0.001). PgR expression levels were not associated with therapeutic schedule and DFS. Patients with tumor tissue Ki67 score ≥30% received more anthracycline- and taxane-based chemotherapy and had worse DFS than those with tumor tissue Ki67 score <30%. Univariate and multivariate analysis showed that clinical T stage, lymph nodes, ER, Ki67, and HER2 status were independent prognostic factors. In conclusion, ER-positive rate <10% and Ki67 score ≥30%, similar to higher clinical T stage, more metastatic lymph nodes, and HER2 positive status, may indicate a worse prognosis for luminal B-like breast cancer patients. Multi-center prospective trials with larger sample sizes are necessary for the continued perfection of our work.
本研究旨在探讨管腔 B 型乳腺癌的预后因素。收集并分析了我院过去 4.5 年期间治疗的 695 例管腔 B 型乳腺癌患者的临床资料。采用免疫组化法检测雌激素受体（ER）、孕激素受体（PgR）、单克隆抗体 Ki-67（Ki67）标记的抗原。评估了不同 ER、PgR 和 Ki67 的截断值。采用 Pearson χ 检验比较分类参数。采用单因素和多因素模型评估无病生存（DFS）的预测因子。结果显示，年龄较小、肿瘤较大、淋巴结阳性较多的患者更有可能接受新辅助化疗（NAC）。ER 阳性肿瘤中阳性细胞<10%的患者接受蒽环类和紫杉类化疗的比例高于 ER 阳性肿瘤中阳性细胞≥10%的患者（P=0.004 和 P=0.007），但前者复发的风险更高（P<0.001）。PgR 表达水平与治疗方案和 DFS 无关。Ki67 评分≥30%的肿瘤组织患者接受更多的蒽环类和紫杉类化疗，DFS 更差。单因素和多因素分析显示，临床 T 分期、淋巴结、ER、Ki67 和 HER2 状态是独立的预后因素。总之，ER 阳性率<10%和 Ki67 评分≥30%，与更高的临床 T 分期、更多转移的淋巴结和 HER2 阳性状态相似，可能预示着管腔 B 型乳腺癌患者的预后较差。需要进行多中心前瞻性试验，以扩大样本量，进一步完善相关研究。
