Sheen-Chen S M, Chou F F, Eng H L, Chen W J
Department of Surgery and Pathology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
Surgery. 1994 Sep;116(3):510-5.
Adjuvant treatment for node-negative breast cancer remains controversial. It is important to pick out the high-risk groups who may benefit from adjuvant systemic therapy and avoid the unnecessary additional therapy for the favorable prognostic groups.
Retrospective study of immunohistochemical staining for HLA-DR on tumor cells from paraffin-embedded tissue specimens of 32 patients with node-negative invasive breast cancer at this hospital from 1986 to 1991 was performed with the aim to investigate its prognostic significance.
HLA-DR staining was positive in nine (28%) patients and negative in twenty-three (72%) patients. One (11%) was a recurrence, and no (0%) death occurred in the positive group, compared with nine (39%) recurrences and five (22%) deaths in the negative group. The multivariate analysis failed to show that HLA-DR expression is an independent prognostic factor. However, with univariate analysis, the 5-year disease-free survival rate (87%) of the positive group was significantly better than that (35%) of the negative group (p = 0.04). The 5-year overall survival rate (100%) of the positive group was also better than that (66%) of the negative group, but the difference was not statistically significant. Furthermore, when combination of the HLA-DR expression and estrogen receptor status was used, both the 5-year disease-free and overall survival rate (81% and 100%, respectively) of group A (positive staining for either HLA-DR or estrogen receptor and positive staining for both) were significantly better than those (33% and 58%, respectively) of group B (negative staining for both HLA-DR and estrogen receptor).
We believe HLA-DR expression may be a promising, additive predictive factor to node-negative breast cancer and deserves further investigation based on these preliminary results.
淋巴结阴性乳腺癌的辅助治疗仍存在争议。挑选出可能从辅助性全身治疗中获益的高危人群，并避免对预后良好人群进行不必要的额外治疗非常重要。
对本院1986年至1991年32例淋巴结阴性浸润性乳腺癌患者石蜡包埋组织标本中肿瘤细胞进行HLA-DR免疫组化染色的回顾性研究，旨在探讨其预后意义。
HLA-DR染色阳性9例（28%），阴性23例（72%）。阳性组1例（11%）复发，无死亡（0%）；阴性组9例（39%）复发，5例（22%）死亡。多因素分析未能显示HLA-DR表达是独立的预后因素。然而，单因素分析显示，阳性组5年无病生存率（87%）显著高于阴性组（35%）（p = 0.04）。阳性组5年总生存率（100%）也高于阴性组（66%），但差异无统计学意义。此外，当联合使用HLA-DR表达和雌激素受体状态时，A组（HLA-DR或雌激素受体阳性染色且两者均为阳性染色）的5年无病生存率和总生存率（分别为81%和100%）均显著高于B组（HLA-DR和雌激素受体均为阴性染色）（分别为33%和58%）。
我们认为HLA-DR表达可能是淋巴结阴性乳腺癌一个有前景的附加预测因素，基于这些初步结果值得进一步研究。
