Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital Sant'Andrea delle Fratte Perugia Italy.
European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy.
Eur J Cancer. 2024 Jan;196:113438. doi: 10.1016/j.ejca.2023.113438. Epub 2023 Nov 14.
The present study was designed to describe tumour features and treatments for patients with breast cancer. It also aimed at assessing the risk of distant metastases in relation to biological profiles, disease stages and treatment.
Data were analysed from 81,882 patients in the EUSOMA database (disease stages at diagnosis 0-IV; median age 61 years; range 20-100 years). All patients were treated between January 2016 and December 2021 in 53 Breast Centres within the EUSOMA certification process in 13 European countries. Cases were classified as HR+ /HER2-, HR+ /HER2 + , HR-/HER2 + or HR-/HER2- and data were analysed accordingly.
Univariable and multivariable analyses for distant metastases were conducted on a subset of 38,119 cases with information on whether or not they had developed them. Potential determinants included sub-group type, Ki67 value, disease stage, adjuvant systemic therapies and post-operative radiation therapy. In multivariable analysis, the HR-/HER2 + and HR-/HER2- sub-groups were associated with a higher risk of distant metastases than HR+ /HER2-. Ki67 > 20 % and advanced stage disease also carried a high risk. Radiation therapy emerged as a protective factor against distant metastases.
Present results show a large patient database offers an information stream that can be applied to reduce uncertainties in clinical practice. Database parameters need to be updated dynamically for outcome monitoring. Molecular prognostic factors, gene-expression signatures, tumour-infiltrating lymphocytes and circulating tumoral DNA should be added.
本研究旨在描述乳腺癌患者的肿瘤特征和治疗方法。还旨在评估与生物特征、疾病分期和治疗相关的远处转移风险。
从 EUSOMA 数据库中的 81882 名患者中分析数据（诊断时疾病分期为 0-IV；中位年龄 61 岁；范围 20-100 岁）。所有患者于 2016 年 1 月至 2021 年 12 月在 EUSOMA 认证过程中的 13 个欧洲国家的 53 个乳腺中心接受治疗。病例根据 HR+/HER2-、HR+/HER2+、HR-/HER2+或 HR-/HER2-进行分类，并进行相应分析。
对 38119 例有远处转移发生信息的病例进行了单变量和多变量分析。潜在的决定因素包括亚组类型、Ki67 值、疾病分期、辅助全身治疗和术后放疗。多变量分析显示，HR-/HER2+和 HR-/HER2-亚组与 HR+/HER2-相比，远处转移的风险更高。Ki67>20%和晚期疾病也有很高的风险。放疗是远处转移的保护因素。
目前的结果表明，大型患者数据库提供了一个信息流，可以应用于减少临床实践中的不确定性。数据库参数需要动态更新以进行结果监测。应添加分子预后因素、基因表达谱、肿瘤浸润淋巴细胞和循环肿瘤 DNA。
