Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Med. 2022 Dec;11(23):4501-4512. doi: 10.1002/cam4.4839. Epub 2022 May 22.
Microinvasive breast cancer (MIBC) is a special type of breast cancer with a relatively low prevalence, of which the understanding remains controversial. In this article, we aimed to clarify the clinicopathological characteristics and prognosis of MIBC in the setting of different molecular subtypes and give feasible suggestions on clinical practice in MIBC.
This study utilized the data from Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into subgroups based on the molecular subtypes, of which the clinicopathological characteristics were further undergone comparative analyses. Kaplan-Meier method and Cox proportional hazard regression analysis were employed to determine the prognosis of the subtypes, and to explore the prognostic factors. Patients were randomly assigned in a 7:3 ratio to the training and validation cohorts. The independent risk variables were then adopted to generate a nomogram to predict the 3- and 5-year survival probability.
A total of 4301 MIBC patients between 2010 and 2016 were obtained from the SEER database, which were subsequently separated into HR+/HER2- (n = 2598), HR+/HER2+ (n = 723), HR-/HER2+ (n = 633), and HR-/HER2- (n = 347) groups. The HR+/HER2+ group showed the best overall survival (OS) (81.28 months, 95% CI 80.45-82.11) compared with other groups (p = 0.0089). The application of radiotherapy in HR+/HER2- and HR+/HER2+ MIBC patients brought out additional survival benefit compared with those without radiotherapy (p < 0.0001 and p = 0.024, respectively). The prognosis among four subgroups with or without chemotherapy showed no statistical difference. Based on the curated nomogram, the high-score group exhibited a better OS compared with patients from the low-score group.
Profound heterogeneity was detected among different molecular subtypes in MIBC patients, of which HR+/HER2+ subtype presented the best prognosis. For HR-positive MIBC patients, increasing survival benefits could be retrieved from radiotherapy. Chemotherapy was not recommended for patients with MIBC. Individual-based protocols were introduced based on the nomogram which warranted further validation.
微浸润性乳腺癌（MIBC）是一种特殊类型的乳腺癌，其发病率相对较低，其认识仍存在争议。本文旨在阐明不同分子亚型中 MIBC 的临床病理特征和预后，并为 MIBC 的临床实践提供可行的建议。
本研究利用了监测、流行病学和最终结果（SEER）数据库的数据。患者根据分子亚型分为亚组，对其临床病理特征进行了进一步的对比分析。采用 Kaplan-Meier 法和 Cox 比例风险回归分析确定各亚型的预后，并探讨预后因素。将患者以 7:3 的比例随机分配到训练和验证队列中。然后采用独立风险变量生成列线图，以预测 3 年和 5 年的生存率。
从 SEER 数据库中获得了 2010 年至 2016 年间的 4301 例 MIBC 患者，随后将其分为 HR+/HER2-（n=2598）、HR+/HER2+（n=723）、HR-/HER2+（n=633）和 HR-/HER2-（n=347）组。与其他组相比，HR+/HER2+组的总体生存率（OS）最佳（81.28 个月，95%CI80.45-82.11）（p=0.0089）。与未接受放疗的患者相比，HR+/HER2-和 HR+/HER2+MIBC 患者接受放疗可带来额外的生存获益（p<0.0001 和 p=0.024）。在接受或不接受化疗的四个亚组中，预后无统计学差异。基于精心设计的列线图，高分组的 OS 优于低分组。
在 MIBC 患者的不同分子亚型中存在明显的异质性，其中 HR+/HER2+亚型的预后最佳。对于 HR 阳性的 MIBC 患者，放疗可增加生存获益。不建议 MIBC 患者进行化疗。基于列线图引入了基于个体的方案，尚需进一步验证。
