Masood S
Department of Pathology, University of Florida Health Science Center/Jacksonville, Jacksonville 32209-6511, USA.
Surg Oncol Clin N Am. 1995 Oct;4(4):601-32.
Approximately 50% of patient with breast cancer ultimately develop metastases, among which only 10% to 15% of patients live 5 years or more. Patients with locally advanced (stage III) breast cancer have a 5-year survival rate of approximately 20% to 30%. Thus, despite high remission rates obtained with current therapies, the poor long-term results associated with the apparent plateau of response achievable with systemic therapies emphasize the necessity of identifying accurate prognostic factors for this group of patients. This will allow an informed discussion with the individual patient. In addition, prognostic information could be used to guide the therapy and also to identify those subgroups of patients who may benefit with less-aggressive therapies. Furthermore, in the context of randomized studies, prognostic factors can be used to stratify patients. Prognostic factors have been extensively studied in early-stage breast cancer. In comparison, only a few studies exist on biologic prognostic factors in advanced breast cancer. Based on the limited information available, it appears that the biologic factors prognostic for locally advanced breast cancer are similar to those reported for early-stage breast cancer. Apparently, certain factors have a prognostic value irrespective of the stage of the disease at the time of presentation. This would then suggest that certain factors maintain their significance as the breast cancer progresses from an overtly local to a systemic disease. It is already well recognized that histologic grade is a significant prognostic factor for early-stage as well as metastatic breast disease. Hormone receptors have been reported to be of prognostic value at all stages of disease. Proliferation rate assessed by a variety of techniques as well as determination of the Nottingham Primary Prognostic Index provides important information about the rate of the growth of the tumor. Thymidine labeling index and S-phase fraction also provide information in regard to response to chemotherapy. DNA ploidy has been reported to be of significance in prediction of response to adjuvant chemotherapy and to a lesser extent to hormone therapy. The value of DNA ploidy in relation to survival in advanced breast cancer, however, remains controversial. Other prognostic factors such as oncogenes, tumor suppressor genes, and growth factors have also shown some predictive value in advanced breast cancer. Similar to what has also been suggested in early breast cancer, much research still needs to be done to clarify the role of currently available prognostic factors and to identify new, more powerful discriminants.(ABSTRACT TRUNCATED AT 400 WORDS)
大约50%的乳腺癌患者最终会发生转移，其中只有10%至15%的患者能存活5年或更久。局部晚期（III期）乳腺癌患者的5年生存率约为20%至30%。因此，尽管目前的治疗方法能取得较高的缓解率，但系统治疗所达到的反应明显平稳期所带来的较差长期结果，凸显了为这类患者确定准确预后因素的必要性。这将有助于与个体患者进行明智的讨论。此外，预后信息可用于指导治疗，还能确定那些可能从较温和治疗中获益的患者亚组。此外，在随机研究的背景下，预后因素可用于对患者进行分层。预后因素在早期乳腺癌中已得到广泛研究。相比之下，关于晚期乳腺癌生物学预后因素的研究较少。基于有限的现有信息，似乎局部晚期乳腺癌的生物学预后因素与早期乳腺癌报道的因素相似。显然，某些因素无论在疾病呈现时处于何种阶段都具有预后价值。这表明某些因素在乳腺癌从明显的局部疾病发展为全身性疾病的过程中仍保持其重要性。组织学分级是早期乳腺癌以及转移性乳腺癌的重要预后因素，这一点已得到充分认识。据报道，激素受体在疾病的各个阶段都具有预后价值。通过多种技术评估的增殖率以及诺丁汉原发性预后指数的测定，提供了有关肿瘤生长速度的重要信息。胸腺嘧啶标记指数和S期分数也提供了有关化疗反应的信息。据报道，DNA倍性在预测辅助化疗反应方面具有重要意义，在激素治疗方面的意义较小。然而，DNA倍性在晚期乳腺癌生存方面的价值仍存在争议。其他预后因素，如癌基因、肿瘤抑制基因和生长因子，在晚期乳腺癌中也显示出一定的预测价值。与早期乳腺癌的情况类似，仍需要进行大量研究以阐明现有预后因素的作用，并确定新的、更有效的判别因素。（摘要截选至400字）
