459例乳腺癌患者21基因复发风险评分的临床意义

Analysis of 21-gene recurrence score in 459 patients with breast cancer

目的探讨乳腺癌21基因复发风险评分的分布情况及其与临床病理特征的相关性,同时探讨21基因复发风险评分在辅助化疗选择中的意义。方法选取接受手术治疗的459例雌激素受体(ER)阳性、人类表皮生长因子受体2(HER2)阴性的乳腺癌患者。提取患者石蜡标本RNA,采用实时荧光聚合酶链反应(PCR)检测21基因(16个乳腺癌相关基因和5个参考基因)的表达,计算21基因复发风险评分并以此分为低危组、中危组和高危组。比较不同21基因复发风险评分亚组与常规临床病理特征的关系以及在辅助化疗选择上的区别,采用多因素Logistic回归分析评估21基因复发风险评分的影响因素。结果 459例乳腺癌患者中低危组117例(25.5%)、中危组254例(55.3%)、高危组88例(19.2%),各组组织学分级、分子分型、孕激素受体(PR)状态及Ki67表达差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示PR状态和组织学分级是21基因复发风险评分危险度分组的影响因素。低危组、中危组和高危组接受化疗的比例有明显差异(P<0.01)。结论 21基因复发风险评分能有效整合一些重要的常规临床病理指标,并提供更多的信息,可以为辅助化疗的选择提供支持。

Objective To investigate the distribution characteristics of21-gene recurrence score and its correlation with clinicopathologic characteristic in breast cancer patients,and to evaluate the role in the choice of adjuvant chemotherapy.Methods A total of459patients with breast cancer were enrolled,who are with positive estrogen receptor(ER)and negative human epidermal growth factor receptor2(HER2).RNA was extracted from the paraffin specimens of patients.Real-time fluorescence polymerase chain reaction(PCR)was used to determine the expression of21-gene,and recurrence score was calculated.According to recurrence score,the patients were classified into low,intermediate and high risk groups.The relationship with clinicopathologic characteristic and the choice of adjuvant chemotherapy in recurrence score groups were evaluated.Multivariate Logistic regression analysis was used to analyze the influence factors for recurrence score.Results Among the459patients with breast cancer,there were117patients(25.5%)in low risk group,254patients(55.3%)in intermediate risk group and88patients(19.2%)in high risk group.There was statistical significance in tumor grade,type,progestin receptor(PR)status and Ki67expression among recurrence score groups(P<0.05).Multivariate Logistic regression analysis showed that PR status and tumor grade were influence factors for recurrence score.There were differences in the proportions of receiving adjuvant chemotherapy among recurrence score groups(P<0.05).Conclusions Recurrence score can effectively integrate some important conventional clinical and pathological indicators,and provide more information.Recurrence score can also support the choice of adjuvant chemotherapy.