21基因在乳腺癌患者复发风险评估中的临床意义

Clinical significance of 21-gene recurrence evaluation in breast cancer patients

目的探讨乳腺癌21基因复发风险评分(CRS)与临床病理特征的相关性及其在辅助化疗选择中的意义。方法回顾性分析2016年10月~2018年4月我院收治的接受21基因检测的Luminal分型乳腺癌患者162例。采用实时荧光聚合酶链反应(PCR)检测21基因的表达并计算其复发风险评分。据复发风险评分分为低危组(n=51)、中危组(n=80)和高危组(n=31)三组。单因素和多因素Logistic回归分析评估21基因复发风险评分与临床病理特征的相关性及评分等级对辅助化疗选择的影响。结果单因素分析结果显示肿块大小(χ^2=11.528,P=0.001)、Ki67表达水平(χ^2=8.273,P=0.016)、分子分型(χ^2=8.864,P=0.003)、CK5/6表达水平(χ^2=30.915,P<0.001)及组织学分级(χ^2=19.513,P<0.001)均影响乳腺癌患者复发风险。多因素条件logistic回归分析结果显示肿块大小(β=1.175,SD=0.467,Wald=6.322,P=0.012,OR=3.238,95%CI:1.296~8.093)以及组织学分级(β=0.671,SD=0.315,Wald=4.541,P=0.033,OR=1.957,95%CI:1.055~3.629)是21基因复发风险评分危险度分组的影响因素。与低危组比较,中、高危组接受化疗的患者更多(χ^2=46.048,P<0.001)。相较于21基因检测之前,低危的浸润性癌有较为明显的治疗决策改变。结论 21基因检测可为早期乳腺癌患者辅助化疗的选择提供参考;分子分型与组织学分级是影响21基因RS的独立影响因素。

Objective To explore the association of 21 gene recurrence score with clinical pathological characteristics and the selection of adjuvant chemotherapeutic strategy. Methods The retrospective study was performed among luminal breast cancer patients from October 2016 to April 2018. Real-time PCR was used for 21 genome detection after RNA extraction, including 16 breast cancer-related genes and 5 reference genes. Patients were enrolled into low risk, moderate risk and high risk groups, based on the calculated RS(recurrence score). Single-factor and logistic analysis were proceeded to investigate the correlation between RS and clinic-pathological features of participants. Besides, the influence of RS level on the decision of adjuvant chemotherapy strategy was also studied. Results 162 luminal breast cancer patients were enrolled. Based on the RS score, patients were grouped into lower risk 51(13.88±2.93, 31.5%), intermediate risk 80(22.42±3.70, 49.4%) and high risk groups 31(35.92±3.17, 16.1%). Single-factor analysis indicated that tumor size(χ^2=11.528,P=0.001), Ki67(χ^2=8.273,P=0.016), molecular subtype(χ^2=8.864,P=0.003), CK5/6 expression(χ^2=30.915,P<0.001), and histological grade(χ^2=19.513,P<0.001) were all affected the risk of recurrence. Logistic analysis results showed the significance of tumor size(β=1.175,SD=0.467,Wald=6.322,P=0.012,OR=3.238,95%CI:1.296-8.093) and histological grade(β=0.671,SD=0.315,Wald=4.541,P=0.033,OR=1.957,95%CI:1.055-3.629). Besides, patients receiving adjuvant chemotherapy in intermediate/high risk groups was higher(χ^2=37.164,P<0.001),while people receiving endocrine therapy was lower than lower group(χ^2=100.309,P<0.001). For radiotherapy treatment, patients in lower risk group prefer to accept endocrine therapy(χ^2=11.388,P=0.001). Conclusion Molecular subtype and histological grade were independent factors to 21 gene recurrence score, which could provide guidance to early breast cancer patients with positive expression of estrogen receptor.