21基因复发风险评分在乳腺浸润性小叶癌中的应用价值

Application value of the 21-gene recurrence score in patients with invasive lobular carcinoma of the breast

目的探讨激素受体阳性腋窝淋巴结阴性乳腺浸润性小叶癌(ILC) 21基因检测结果与临床病理特征及预后的相关性,评估21基因复发风险(RS)评分在ILC的应用价值。方法回顾性分析2012年5月至2015年12月北京协和医院32例行21基因RS评分的ILC患者的临床病理资料并进行随访,选取同期同年龄段301例行21基因RS评分的浸润性癌(非特殊型)(NST)患者作为对照组。结果 32例ILC患者中,低危(RS<18)及中危(18≤RS<31)组分别占87. 5%和12. 5%,无患者进入高危组(RS≥31)。301例NST患者中,低危、中危和高危组分别占64. 5%、26. 6%和9. 0%。ILC和NST两组的RS评分有差异(P<0. 05)。ILC和NST在肿瘤分级和Ki-67指数上有差异(P<0. 05)。中位随访38个月的结果显示,32例ILC中无一例出现复发转移,NST对照组中低危组的复发转移事件率(3. 6%)明显低于中危组(8. 8%)和高危组(11. 1%)。结论 ILC与NST的RS分组差异显著,ILC中高危组比例明显低于NST。RS对ILC化疗决策的辅助指导作用仍不甚明朗。RS对ILC的预后判断价值尚需更多的临床研究的数据方可定论。

Objective To explore the association of 21 gene recurrence score (RS) and pathological characteristics and prognosis of axillary lymph node negative,hormone receptor (HR) positive invasive lobular carcinoma of the breast (ILC) and to evaluate the application value of 21 gene RS in ILC.Methods The pathological data of 32 ILC who underwent 21 gene RS testing from May 2012 to December 2015 was retrospectively analyzed.At meantime,301 invasive carcinoma of no special type (NST) were selected from the same hospital as control group.Results In 32 ILC patients,low risk (RS<18),intermediate risk (18≤RS<31) and high risk (RS≥31) group accounted for 87.5%,12.5% and 0%.While in 301 NST patients,low,intermediate and high risk group accounted for 64.5%,26.6% and 9.0%.There were significant differences in RS between ILC and NST groups (P<0.05).Tumor grade and Ki-67 index were significantly different between the 2 groups (P<0.05l).After a median follow-up of 38 months,no recurrence occurred in 32 ILC and the recurrence rate of low,intermediate and high risk group in NST cohort was 3.6%,8.8% and 11.1%.Conclusions The difference of RS distribution between ILC and NST was significant,and the proportion of high-risk group in ILC was significantly lower than that of NST.The role of RS in ILC chemotherapy decision-making remains unclear.The prognostic value of RS for ILC remains to be determined by more clinical investigation.