Niskanen E, Blomqvist C, Franssila K, Hietanen P, Wasenius V M
Department of Oncology, University of Helsinki, Finland.
Br J Cancer. 1997;76(7):917-22. doi: 10.1038/bjc.1997.484.
The value of various prognostic factors in breast cancer patients has been determined in a number of studies. Few reports have been published on the dependence of treatment outcome on histological and immunohistochemical characteristics in the primary tumour in patients with metastatic disease. We studied the incidence and prognostic value of histological and molecular abnormalities in the primary tumour of patients who had developed metastatic breast cancer. Eligible patients received a fluorouracil, epirubicin and cyclophosphamide (FEC) regimen either once a week or once every 4 weeks. Adequate specimens for various analyses were available from 127 patients. Median follow-up time of the patients ranged from 15 to 101 months. In this study, the histological grade of the malignancy best predicted response to chemotherapy (P < 0.0005). Most of the responses were observed in patients with grade 1 tumours; in this group, time to progression was delayed. C-erb B-2 gene amplification and oncoprotein expression had no predictive value. Neither p53 nor cathepsin-D predicted treatment outcome after chemotherapy. None of the factors had an effect on overall survival. Among breast cancer patients who received anthracycline-containing chemotherapy, response to treatment correlated with histological grade. In patients with histological grade 1 breast cancer, the time to progression was longest. However, overall survival was not affected by histological grade nor the other parameters tested. In addition to histological grade, other prognostic factors that are not included in this study need to be identified to determine which patients with metastatic breast cancer would benefit from cytotoxic treatment.
多项研究已确定了乳腺癌患者各种预后因素的价值。关于转移性疾病患者原发肿瘤的组织学和免疫组化特征对治疗结果的依赖性，发表的报告较少。我们研究了发生转移性乳腺癌患者原发肿瘤的组织学和分子异常的发生率及预后价值。符合条件的患者接受氟尿嘧啶、表柔比星和环磷酰胺（FEC）方案治疗，每周一次或每4周一次。127例患者有可用于各种分析的充足标本。患者的中位随访时间为15至101个月。在本研究中，恶性肿瘤的组织学分级最能预测化疗反应（P<0.0005）。大多数反应见于1级肿瘤患者；在该组中，疾病进展时间延迟。C-erb B-2基因扩增和癌蛋白表达无预测价值。p53和组织蛋白酶-D均不能预测化疗后的治疗结果。这些因素均对总生存期无影响。在接受含蒽环类化疗的乳腺癌患者中，治疗反应与组织学分级相关。在组织学1级乳腺癌患者中，疾病进展时间最长。然而，总生存期不受组织学分级及其他所检测参数的影响。除组织学分级外，还需要确定本研究未纳入的其他预后因素，以确定哪些转移性乳腺癌患者将从细胞毒性治疗中获益。
