Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cancer Med. 2020 Sep;9(17):6173-6185. doi: 10.1002/cam4.3305. Epub 2020 Jul 13.
Features in preoperative ultrasound could predict the prognosis of triple-negative breast cancer (TNBC), while its prognostic value in other molecular subtypes of breast cancer (BC) was unknown. The study aimed to assess the prognostic value of preoperative sonographic features, including orientations, on long-term outcomes in BC and its association with different molecular subtypes.
Women diagnosed with invasive BC > 5 mm who underwent surgery were retrospectively reviewed. Clinical, pathological, and sonographic profiles were collected and recurrence-free survival (RFS) and breast cancer-specific survival (BCSS) were reported. Interactions between clinicopathological features and tumor orientations in predicting RFS and BCSS were analyzed. Competing risk model was performed to estimate prognostic values of sonographic features for RFS and BCSS.
A total of 2812 patients were included. With a median follow-up of 60.0 months, 268 (9.5%) patients suffered from recurrences and 104 (3.7%) died of BC. The prognostic values of vertical orientation in predicting RFS (P = .001) and BCSS (P = .001) were strongly associated with molecular subtypes. Non-TNBC tumors with vertical orientation had less recurrence events compared with parallel orientation (6.3% vs 8.7%, P = .035), whereas failed to predict disease outcomes in multivariate analysis (P > .05). Oppositely, in TNBC, vertical orientation was associated with worse RFS (HR = 3.50; 95% confidence interval [CI] 1.69-7.24; P < .001) and BCSS (HR = 6.36; 95% CI 2.86-14.14; P < .001) in multivariate analysis with a 5-year RFS and BCSS of 73.4% and 74.6%. Meanwhile, vertical orientation was related with smaller tumor size (P < .001), human epidermal growth factor receptor 2 nonamplification (P < .001), and lower Ki-67 expression (P = .001) among non-TNBC population, whereas TNBC tumors with vertical orientation had a higher burden of axillary lymph node metastases (2.8 ± 1.0 vs 1.4 ± 0.2, P = .001).
Prognostic values of sonographic orientation in predicting BC disease outcomes were associated with molecular subtypes. Vertical orientation in preoperative sonogram may serve as a prognostic biomarker for TNBC patients.
术前超声特征可预测三阴性乳腺癌（TNBC）的预后，但其在其他乳腺癌（BC）分子亚型中的预后价值尚不清楚。本研究旨在评估术前超声特征（包括肿瘤方位）在 BC 及其与不同分子亚型中的长期预后中的预测价值。
回顾性分析接受手术治疗的浸润性 BC ＞ 5mm 的女性。收集临床、病理和超声特征，并报告无复发生存率（RFS）和乳腺癌特异性生存率（BCSS）。分析临床病理特征与肿瘤方位之间在预测 RFS 和 BCSS 中的相互作用。使用竞争风险模型评估超声特征对 RFS 和 BCSS 的预后价值。
共纳入 2812 例患者。中位随访 60.0 个月，268 例（9.5%）患者出现复发，104 例（3.7%）死于 BC。垂直方位在预测 RFS（P=.001）和 BCSS（P=.001）方面的预后价值与分子亚型密切相关。与平行方位相比，具有垂直方位的非 TNBC 肿瘤的复发事件更少（6.3% vs. 8.7%，P=.035），但在多变量分析中无法预测疾病结局（P＞.05）。相反，在 TNBC 中，垂直方位与较差的 RFS（HR=3.50；95%置信区间[CI]1.69-7.24；P＜.001）和 BCSS（HR=6.36；95%CI 2.86-14.14；P＜.001）相关，具有 5 年 RFS 和 BCSS 分别为 73.4%和 74.6%。同时，垂直方位与非 TNBC 人群中的肿瘤较小（P＜.001）、人表皮生长因子受体 2 非扩增（P＜.001）和 Ki-67 表达较低（P=.001）相关，而具有垂直方位的 TNBC 肿瘤腋窝淋巴结转移负担更高（2.8±1.0 vs. 1.4±0.2，P=.001）。
术前超声特征预测 BC 疾病结局的预后价值与分子亚型有关。术前超声图像的垂直方位可能成为 TNBC 患者的预后生物标志物。
