乳腺癌病人的21基因复发风险评分与临床病理特征

21-gene recurrence score and clinicopathological feature in breast cancer patients

目的:分析激素受体阳性的早期乳腺癌病人21基因复发风险评分(recurrence score,RS)与临床病理特征的相关性,并比较不同管腔(luminal)型乳腺癌划分标准与RS的关系。方法:收集2014年1月至2015年6月瑞金医院乳腺疾病诊治中心手术治疗后接受21基因检测的早期女性乳腺癌病人,回顾分析RS与临床病理特征的相关性。结果:共入组379例病人,其中低危RS 86例(22.7%),中危RS 229例(60.4%),高危RS 64例(16.9%)。单因素分析结果显示,在不同雌激素受体、孕激素受体(progesterone receptor,PgR)、Ki67表达及组织学分级的乳腺癌病人中,RS存在统计学差异(P值分别为0.011,<0.001,<0.001,<0.001)。多因素分析表明,PgR、Ki67表达及组织学分级是RS评分的独立影响因素(P值分别为0.001,0.006,0.045)。分别以Ki67≥14%和≥20%作为luminal A型和luminal B型乳腺癌的划分标准,进行RS的分层分析显示,两者的RS较为一致。结论 :在激素受体阳性早期乳腺癌病人中,Pg R、Ki67及组织学分级是影响RS的独立影响因素。根据Ki67不同表达水平进行luminal A型和luminal B型乳腺癌的划分,不影响RS。

Objective To analyze the correlation between 21-gene recurrence score（RS） and the clinicopathological features in the patients with hormone receptor-positive early breast cancer as well as luminal cancer classification asso-ciated with RS. Methods This was a retrospective study performed from January 2014 to June 2015 in Comprehensive Breast Health Center, Ruijin Hospital. RS assay was done and calculated. The correlation between RS in the patients with hormone receptor-positive early breast cancer and clinicopathological features was analyzed. Results A total of 379 patients was enrolled in this study. There were 86 cases with low risk（22.7%）, 229 cases with moderate risk（60.4%） and 64 cases with high risk（16.9%）. It was shown by univariate analysis that estrogen receptor（ P=0.011）, progesterone receptor（Pg R）（P〈0.001）, Ki67 status（P〈0.001） and tumor grade（P〈0.001） were significantly correlated with RS respectively. Multivariate Logistic regression showed that Pg R（P=0.001）, Ki67 status（P=0.006） and tumor grade（P=0.045） were independent significant risk factors of RS. By using 14% and 20% as Ki67 cutoff point to discriminate luminal A and B breast cancer, the results of RS remained similar. Conclusions PgR, Ki67 status and tumor grade are independent factors of RS in hormone receptor-positive early breast cancer patients. Different luminal cancer classification does not affect the RS.