21基因复发风险评分在乳腺黏液癌中的临床应用价值

21-Gene recurrence score in mucinous breast cancer

目的探讨21基因复发风险评分在乳腺黏液癌(MBC)中的临床应用价值。方法选取接受手术治疗的96例雌激素受体(ER)阳性、人类表皮生长因子受体2(HER-2)阴性的MBC患者,收集所有患者的临床资料。提取所有患者肿瘤组织石蜡包埋标本中的RNA,采用实时荧光定量聚合酶链反应(PCR)检测21基因的表达,计算21基因复发风险评分,根据评分结果将所有患者分为低危组(<18分)、中危组(18~30分)和高危组(>30分)。采用多因素Logistic回归分析评估21基因复发风险评分的独立影响因素。采用Kaplan-Meier生存曲线评估无病生存期(DFS)。结果96例MBC患者中低危组23例(24.0%)、中危组63例(65.6%)、高危组10例(10.4%)。低危组、中危组及高危组之间孕激素受体(PR)表达、分子分型及肿块大小差异均有统计学意义(P<0.05),年龄、绝经时间、stage分期、Ki67表达差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,PR低表达是MBC患者21基因复发风险评分为高危的独立危险因素[比值比(OR)=7.271,95%可信区间(CI)为0.728~3.240]。化疗的选择与Ki67表达、分子分型、PR表达及21基因复发风险评分有关(P<0.05),与年龄、肿块大小、绝经时间、手术方式、stage分期无关(P>0.05)。多因素Logistic回归分析结果显示,21基因复发风险评分及Ki67表达是选择化疗的独立影响因素(P<0.05)。Kaplan-Meier生存曲线分析结果显示,低危组、中危组及高危组之间DFS差异均无统计学意义(P>0.05)。结论在MBC患者中,21基因复发风险评分与PR表达密切相关,是辅助化疗选择的独立影响因素,但不能预测患者DFS的长短。

Objective To investigate the clinical value of 21-gene recurrence score(RS)in mucinous breast cancer(MBC).Methods Totally,96 MBC patients with estrogen receptor(ER)positive and human epidermal growth factor receptor 2(HER-2)negative who underwent surgical treatment were enrolled,and the clinical data of all the patients were collected.RNA was extracted from the tumor paraffin specimens of patients.Real-time fluorescence quantitative polymerase chain reaction(PCR)was used to determine the expression of 21 genes,and 21-gene RS was calculated.According to the scores,all the patients were classified into low-risk group(<18 points),intermediate-risk group(18-30 points)and high-risk group(>30 points).Logistic regression was used to analyze the influence factors of 21-gene RS.Kaplan-Meier curve was used to assess disease-free survival(DFS).Results Among the 96 patients with breast cancer,there were 23 patients(24.0%)in the low-risk group,63 patients(65.6%)in the intermediate-risk group and 10 patients(10.4%)in the high-risk group.There was statistical significance in progestin receptor(PR)expression,molecular typing and tumor size among the low-risk group,intermediate-risk group and high-risk group(P<0.05).There was no statistical significance in age,menopausal time,staging and Ki67 expression(P>0.05).Multivariate analysis demonstrated that PR status was independently associated with high risk based on 21-gene RS[odds ratio(OR)=7.271,95%confidence interval(CI)0.728-3.240].Univariate analysis found that the choice of chemotherapy was related to Ki67 expression,molecular typing,PR expression and 21-gene RS(P<0.05).There was no correlation in age,tumor size,menopausal time,operation method and staging(P>0.05).Multivariate analysis showed that Ki67 expression and 21-gene RS independently influenced the use of chemotherapy(P<0.05).No statistical significance in DFS was found among MBC patients in different 21-gene RS subgroups(P>0.05).Conclusions 21-Gene RS is related to PR status in MBC patients.21-Gene RS does independently affect the choice of chemotherapy.However,21-gene RS is not able to predict DFS in MBC patients.