ASO：乳腺癌亚型并非局部控制的有效预测变量

尽管目前认为，免疫组化染色法确定的乳腺癌亚型(BCS)与分子亚型及患者预后和结局有关，但BCS与腋窝淋巴结侵犯间关系的文献却较为匮乏。为此，美国耶鲁大学医学院的Meena S. Moran博士等人进行了一项研究，该研究旨在评价BCS是否可以预测淋巴结转移，并评价BCS是否与其他临床病理学表现特征存在关联。这项研究结果发表于2013年5月10日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。

研究人员针对接受保乳手术治疗并可进行腋窝手术组织块评价的I/II期患者，进行了病理学考察，并建立了相关的组织芯片。通过载片的雌激素受体、孕酮受体及HER-2/neu (HER-2)染色结果进行BCS分类。并通过淋巴结侵犯及其他临床病理特征分析，对BCS与患者和肿瘤特征间的联系进行了评价。最终计算得到BCS与结局间的函数。

研究队列共包括453例患者(管腔A型， 48.6 %,管腔B型，16.1 %, HER-2型，11.0 %, 三阴型，24.2 %)，其中22 % (n = 113)患者淋巴结呈阳性。研究结果表明，BCS与pN分期、淋巴结阳性或受累淋巴结绝对数目间并无显著关系(所有p > 0.05)。然而单变量及多变量分析结果显示，肿瘤亚型与发病时年龄(p < 0.001)、检测方法(p < 0.001)、肿瘤病理(p < 0.001)、患者种族(p = 0.041)及瘤体大小(pT 分期, p < 0.001)间存在显著关系。与预期结果一致，患者10年结局随BCS不同而存在差异，三阴亚型与HER-2亚型患者总生存时间(p = 0.03)、无病生存时间(p = 0.03)及无远端转移生存时间(p < 0.01)方面较差。

研究人员据此认为，BCS与患者年龄、T分期、组织学结果、检测方法及种族间存在显著关系，但与淋巴结受累预测间并无关联。如得到进一步证实，可通过该研究结果推断认为，从局部控制角度而言，BCS可能并不是一种有效的预测变量。

Are Breast Cancer Subtypes Prognostic for Nodal Involvement and Associated with Clinicopathologic Features at Presentation in Early-Stage Breast Cancer?
BACKGROUND
Breast cancer subtypes (BCS) determined from immunohistochemical staining have been correlated with molecular subtypes and associated with prognosis and outcomes, but there are limited data correlating these BCS and axillary node involvement. This study was conducted to assess whether BCS predicted for nodal metastasis or was associated with other clinicopathologic features at presentation.
METHODS
Patients with stage I/II disease who underwent breast-conserving surgery and axillary surgical assessment with available tissue blocks underwent a institutional pathological review and construction of a tissue microarray. The slides were stained for estrogen receptor, progesterone receptor, and HER-2/neu (HER-2) for classification into BCS. Nodal involvement and other clinicopathologic features were analyzed to assess associations between BCS and patient and tumor characteristics. Outcomes were calculated a function of BCS.
RESULTS
The study cohort consisted of 453 patients (luminal A 48.6 %, luminal B 16.1 %, HER-2 11.0 %, triple negative 24.2 %), of which 22 % (n = 113) were node positive. There were no significant associations with BCS and pN stage, node positivity, or absolute number of nodes involved (p > 0.05 for all). However, there were significant associations with subtype and age at presentation (p < 0.001), method of detection (p = 0.049), tumor histology (p < 0.001), race (p = 0.041), and tumor size (pT stage, p < 0.001) by univariate and multivariate analysis. As expected, 10-year outcomes differed by BCS, with triple negative and HER-2 subtypes having the worse overall (p = 0.03), disease-free (p = 0.03), and distant metastasis-free survival (p < 0.01).
CONCLUSIONS
There is a significant association between BCS and age, T stage, histology, method of detection, and race, but no associations to predict nodal involvement. If additionally validated, these findings suggest that BCS may not be a useful prognostic variable for influencing regional management considerations.