Sjögren S, Inganäs M, Lindgren A, Holmberg L, Bergh J
Department of Oncology, Akademiska Sjukhuset, Uppsala University, Sweden.
J Clin Oncol. 1998 Feb;16(2):462-9. doi: 10.1200/JCO.1998.16.2.462.
To investigate the prognostic and predictive value of c-erbB-2 overexpression in breast cancer in relation to other prognostic markers.
Paraffin-embedded tumors from 315 consecutive primary breast cancer patients were screened for c-erbB-2 protein (p185) overexpression by immunohistochemistry using the monoclonal antibody CB11.
c-erbB-2 protein overexpression was detected in 19% of tumors and was associated with shorter 5-year overall survival (OAS) rate compared with c-erbB-2-negative cases in the total patient material (58% and 77%, respectively; P = .004) and in the 96 node-positive patients (31% and 61%, respectively; P = .02), but not in node-negative patients. For 47 node-positive patients treated with adjuvant tamoxifen and radiotherapy, the 5-year OAS was 13% for c-erbB-2 overexpression and 75% for c-erbB-2-negative patients (P = .00004). The frequency of c-erbB-2 overexpression decreased with age at diagnosis. The prognostic value of c-erbB-2 on OAS was independent of age, node status, tumor size, histopathologic grade, hormone receptor status, S phase, p53 status, and adjuvant treatment. c-erbB-2 status added prognostic information to p53-negative and low S-phase cases, but not to p53-positive and high S-phase cases. Correspondingly, these only added information to c-erbB-2-negative cases.
c-erbB-2 protein overexpression may have a predictive value with regard to adjuvant therapy in node-positive patients, for whom adjuvant tamoxifen with radiotherapy appears insufficient in the presence of c-erbB-2 overexpression. Combination of conventional and newer tumor markers may identify patients with a worse prognosis within groups with a generally favorable prognosis.
研究c-erbB-2过表达在乳腺癌中的预后及预测价值，并与其他预后标志物进行关联分析。
采用单克隆抗体CB11，通过免疫组织化学方法对315例连续的原发性乳腺癌患者石蜡包埋肿瘤组织进行c-erbB-2蛋白（p185）过表达筛查。
在19%的肿瘤中检测到c-erbB-2蛋白过表达，与c-erbB-2阴性病例相比，在全部患者材料中（分别为58%和77%；P = 0.004）以及96例淋巴结阳性患者中（分别为31%和61%；P = 0.02），5年总生存率较低，但在淋巴结阴性患者中未观察到这种差异。对于47例接受辅助他莫昔芬和放疗的淋巴结阳性患者，c-erbB-2过表达患者的5年总生存率为13%，c-erbB-2阴性患者为75%（P = 0.00004）。c-erbB-2过表达的频率随诊断时年龄的增加而降低。c-erbB-2对总生存率的预后价值独立于年龄、淋巴结状态、肿瘤大小、组织病理学分级、激素受体状态、S期、p53状态和辅助治疗。c-erbB-2状态为p53阴性和S期低的病例增加了预后信息，但对p53阳性和S期高的病例没有作用。相应地，这些指标仅为c-erbB-2阴性病例增加了信息。
c-erbB-2蛋白过表达对于淋巴结阳性患者的辅助治疗可能具有预测价值，对于存在c-erbB-2过表达的患者，辅助他莫昔芬联合放疗似乎不足。传统和新型肿瘤标志物的联合使用可能有助于在总体预后较好的患者群体中识别预后较差的患者。
