不同分子分型乳腺癌临床病理特征及预后分期分析
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摘要
目的探讨不同分子分型乳腺癌的临床病理特征及预后分期系统对其分期评价的意义。方法选取236例乳腺癌病人,参照2017年版中国抗癌协会乳腺癌诊治指南与规范进行分子分型,对不同分子分型乳腺癌病人的临床病理特征进行分析,并且根据第8版美国癌症联合委员会(AJCC)乳腺癌分期标准重新评价不同分子亚型解剖分期及预后分期,比较每一种分子亚型乳腺癌中不同解剖学分期下预后分期变化的特点。结果不同分子分型乳腺癌病人之间组织学分级、Ki-67表达、淋巴结转移、解剖学分期及预后分期差异有统计学意义(P<0.05),而肿瘤大小差异无统计学意义(P>0.05);预后分期与解剖学分期比较发生变化,各分子亚型间变化特点差异具有统计学意义(P<0.05),不同分子亚型乳腺癌中各解剖学分期的预后分期变化差异有统计学意义(P<0.05)。结论不同分子亚型乳腺癌之间具有异质性,与解剖学分期相比,不同分子亚型预后分期变化特点不同,分子分型结合预后分期可为乳腺癌精准个体化治疗方案提供临床依据。
Objective To investigate the clinicopathological characteristics and the meaning of staging evaluation by the prognostic staging system of breast cancer with different molecular types.Methods Clinicopathologic data of 236 breast cancer cases,which confirmed by surgical treatment.2018.According to the 2017 CACA guidelines of breast cancer diagnosis and treatment distinguished different molecular subtypes,and compared clinicopathological characteristics of different molecular subtypes.The study reappraised the anatomic staging and prognostic staging according to the AJCC staging criteria for breast cancer,and compared the changing characteristics of prognostic staging in different anatomical stages of each molecular subtype.Results The study found different subtypes show statistical significant differences in histological grading、 Ki-67 level、lymph node metastasis、anatomical stage and prognosis stage(P<0.05),but not in tumor size(P>0.05).Compared with anatomical stage,the prognosis stage changed,and there were statistical significant among subtypes(P<0.05).The changing characteristics of prognostic staging in different anatomical stages of each molecular subtype is significant(P<0.05).Conclusion There is heterogeneity among different molecular subtypes.Compared with anatomical stage,the changing characteristics of prognostic staging is vary from molecular subtype.Molecular typing combined with prognostic staging maybe provided an important basis for accurated individualized treatment of breast cancer.
Objective To investigate the clinicopathological characteristics and the meaning of staging evaluation by the prognostic staging system of breast cancer with different molecular types.Methods Clinicopathologic data of 236 breast cancer cases,which confirmed by surgical treatment.2018.According to the 2017 CACA guidelines of breast cancer diagnosis and treatment distinguished different molecular subtypes,and compared clinicopathological characteristics of different molecular subtypes.The study reappraised the anatomic staging and prognostic staging according to the AJCC staging criteria for breast cancer,and compared the changing characteristics of prognostic staging in different anatomical stages of each molecular subtype.Results The study found different subtypes show statistical significant differences in histological grading、 Ki-67 level、lymph node metastasis、anatomical stage and prognosis stage(P<0.05),but not in tumor size(P>0.05).Compared with anatomical stage,the prognosis stage changed,and there were statistical significant among subtypes(P<0.05).The changing characteristics of prognostic staging in different anatomical stages of each molecular subtype is significant(P<0.05).Conclusion There is heterogeneity among different molecular subtypes.Compared with anatomical stage,the changing characteristics of prognostic staging is vary from molecular subtype.Molecular typing combined with prognostic staging maybe provided an important basis for accurated individualized treatment of breast cancer.
引文
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[12] Wen G,Zhang JS,Zhang YJ,et al.Predictive Value of Molecular Subtyping for Locoregional in Early-Staging Breast Cancer with N1 without Postmastectomy Radiotherapy[J].J Breast,2016,19(2):176-184.
[13] Yao K,Goldschmidt R,Turk M,et al.Molecular subtyping improves diagnostic stratification of Patients with primary breast cancer into prognostically defined risk groups[J].Breast Cancer Res Treat,2015,154(1):81-88.
[14] 刘荫华,刘世伟,张虹,等.人类表皮生长因子受体2阳性乳腺癌新辅助治疗热点问题[J].浙江医学,2016,38(3):163-166.
[2] Krishnamurti U,Wetherilt CS,Yang J,et al.Tumor-infiltrating lymphocytes are significantly associated with better overall survival and disease-free survival in triple negative but not estrogen receptor postive breast cancer[J].Hum Pathol,2017,64:7-12.
[3] Yang ZJ,Yu Y,Chi JR,et al.The combined pN stage and breast cancer subtypes in breast cancer:a better Discriminator of outcomes can be used to refine the 8th AJCC staging manual[J].Breast cancer,2018,25(3):315-324.
[4] Shibuta K,Ueo H,Furusawa H,et al.The relevance of intrinsic subtype to clinicopathological featurs and prognosis in 4,266 Japanese women with breast cancer[J].Breast cancer,2011,18(4):292-298.
[5] 中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):695-759.
[6] Amin MB,Edge S,Greene FL,et al.AJCC Cancer Staging Manual[M].8th ed.New York:Spring,2016:589-628.
[7] 刘钟芬,陈创,姚晓莉,等.乳腺癌不同分子分型的临床病理特点及预后分析[J].中华医学杂志,2016,96(22):1733-1737.
[8] Weiss A,King TA,Hunt KK,et al.Incorporating biologic factors into the american joint committee on cancer breast cancer staging system:review of the supporting evidence[J].Surg Clin North Am,2018,98(4):687-702.
[9] Kim I,Choi HJ,Ryu JM,et al.Prognostic validation of the american joint committee on cancer 8th staging system in 24,014 Korean patients with breast cancer[J].J Breast Cancer,2018,21(2):173-181.
[10] Wong RX,Wong FY,Lim J,et al.Validation of the AJCC 8th prognostic system for breast cancer in an Asian healthcare setting[J].Breast,2018,40:38-44.
[11] Ye J,Wang W,Xu L,et al.A retrosppective prognostic evaluation analysis using the 8th edition of American Joint Committee on Cancer(AJCC)cancer staging system for luminal A breast cancer[J].Chin J Cancer Res,2017,29(4):351-360.
[12] Wen G,Zhang JS,Zhang YJ,et al.Predictive Value of Molecular Subtyping for Locoregional in Early-Staging Breast Cancer with N1 without Postmastectomy Radiotherapy[J].J Breast,2016,19(2):176-184.
[13] Yao K,Goldschmidt R,Turk M,et al.Molecular subtyping improves diagnostic stratification of Patients with primary breast cancer into prognostically defined risk groups[J].Breast Cancer Res Treat,2015,154(1):81-88.
[14] 刘荫华,刘世伟,张虹,等.人类表皮生长因子受体2阳性乳腺癌新辅助治疗热点问题[J].浙江医学,2016,38(3):163-166.
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