Suelmann B B M, van Dooijeweert C, van der Wall E, Linn S, van Diest P J
Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, Utrecht, GA, 3508, The Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
Breast Cancer Res Treat. 2021 Apr;186(3):699-704. doi: 10.1007/s10549-021-06130-w. Epub 2021 Feb 26.
Breast cancer is the most common type of malignancy in pregnant women, occurring approximately once in every 3000 pregnancies. Pregnancy-associated breast cancer (PABC) is commonly defined as breast cancer diagnosed during or within one year after pregnancy, and it accounts for up to 6.9% of all breast cancers in women younger than 45 years old. Whether these cancers arise before or during pregnancy, and whether they are stimulated by the high hormonal environment of pregnancy, is currently unknown. This study assesses the histopathological profile of PABC in a large Dutch population-based cohort.
We identified 744 patients with PABC (in this cohort defined as breast cancer diagnosed during or within 6 months after pregnancy) diagnosed between 1988 and 2019, in the nationwide Dutch Pathology Registry (PALGA). An age-matched PALGA cohort of unselected breast cancer patients (≤ 45 years), diagnosed between 2013 and 2016, was used as a control. Histopathologic features of both cohorts were compared.
The median age of PABC patients was 34.3 years old (range 19-45 years) and most breast cancers were diagnosed during pregnancy (74.2%). As compared to age-matched controls, PABC patients had tumors of higher Bloom-Richardson grade (grade I: 1.5% vs. 12.4%, grade II: 16.9% vs. 31.3%, grade III: 80.3% vs. 39.5%, p < 0.0001). Furthermore, estrogen (ER)- and progesterone (PR)-receptor expression was less frequently reported positive (ER: 38.9% vs. 68.2% and PR: 33.9% vs. 59.0%, p < 0.0001), while a higher percentage of PABC tumors overexpressed HER2 (20.0% vs. 10.0%, p < 0.0001). The most observed intrinsic subtype in PABC was triple-negative breast cancer (38.3% vs. 22.0%, p < 0.0001), whereas hormone-driven cancers were significantly less diagnosed (37.9% vs. 67.3%, p < 0.0001).
This study, based on a large population-based cohort of 744 PABC Dutch patients, underlines the more aggressive histopathologic profile compared to age-matched breast cancer patients ≤ 45 years. Further in-depth genetic analysis will be performed to unravel the origin of this discriminating phenotype. It definitely calls for timely detection and optimal treatment of this small but delicate subgroup of breast cancer patients.
乳腺癌是孕妇中最常见的恶性肿瘤类型，大约每3000次妊娠中会出现1例。妊娠相关乳腺癌（PABC）通常定义为在妊娠期间或妊娠后1年内诊断出的乳腺癌，在45岁以下女性的所有乳腺癌中占比高达6.9%。目前尚不清楚这些癌症是在妊娠前还是妊娠期间发生，以及它们是否受到妊娠高激素环境的刺激。本研究评估了荷兰一个大型基于人群的队列中PABC的组织病理学特征。
我们在荷兰全国病理登记处（PALGA）中确定了1988年至2019年间诊断出的744例PABC患者（在本队列中定义为在妊娠期间或妊娠后6个月内诊断出的乳腺癌）。将2013年至2016年间诊断出的年龄匹配的未选择乳腺癌患者（≤45岁）的PALGA队列用作对照。比较了两个队列的组织病理学特征。
PABC患者的中位年龄为34.3岁（范围19 - 45岁），大多数乳腺癌在妊娠期间被诊断出（74.2%）。与年龄匹配的对照组相比，PABC患者的肿瘤具有更高的布卢姆-理查森分级（I级：1.5%对12.4%，II级：16.9%对31.3%，III级：80.3%对39.5%，p < 0.0001）。此外，雌激素（ER）和孕激素（PR）受体表达呈阳性的报告频率较低（ER：38.9%对68.2%，PR：33.9%对59.0%，p < 0.0001），而PABC肿瘤中HER2过表达的比例更高（20.0%对10.0%，p < 0.0001）。PABC中最常见的内在亚型是三阴性乳腺癌（38.3%对22.0%，p < 0.0001），而激素驱动型癌症的诊断明显较少（37.9%对67.3%，p < 0.0001）。
这项基于744例荷兰PABC患者的大型人群队列研究强调，与年龄匹配的≤45岁乳腺癌患者相比，PABC具有更具侵袭性的组织病理学特征。将进行进一步的深入基因分析，以揭示这种有区别的表型的起源。这无疑呼吁对这一小而特殊的乳腺癌患者亚组进行及时检测和优化治疗。
