70基因谱(MammaPrint)检测乳腺癌的应用进展分析

Analysis of the Application Progress of MammaPrint 70 Gene Spectrum in Detecting Breast Cancer

乳腺癌是一种高度异质性疾病,只有在早期诊断和有效治疗的情况下被认为才可以治愈。直到本世纪初,肿瘤学家一直依赖经典的临床和病理变量来辅助化疗决策,但结果令人非常不满意,特别是对风险较低的非阴性疾病患者,综合所有变量往往会导致所谓的灰色地带和过度治疗的高风险。在MINDACT试验开始之前,没有就化疗使用的考虑进行正式的文献搜索,但有一个高度未得到满足的临床需求是显著的,并在21世纪初被记录在案,这表明许多早期乳腺癌患者被过度化疗。美国临床肿瘤协会(ASCO)批准了两个多基因标记,21基因复发评分(Oncotype DX,美国)和70基因预测标记(MammaPrint,Agendia,阿姆斯特丹,荷兰),已经显示出一级临床效用,可用以识别接受辅助内分泌治疗而不接受化疗的患者的预后。现针对MammaPrint基因检测系统的开发和前瞻性临床试验MINDACT等研究进展进行了统一综述,希望增加对其的认识。

Breast cancer is a highly heterogeneous disease that can only be considered curable if it is diagnosed early and treated effectively.Until the beginning of this century,oncologists relied on classical clinical and pathological variables to aid chemotherapy decisions,but remained highly unsatisfied,especially for patients with low-risk non-negative disease,for whom a combination of all variables often led to so-called gray areas and a high risk of overtreatment.Prior to the start of the MINDACT trial,there was no formal literature search for consideration of chemotherapy use,but a high degree of unmet clinical need became apparent and documented in the early 21st century,suggesting that many patients with early-stage breast cancer were overtreated with chemotherapy.The American Society of Clinical Oncology(ASCO)has approved two multi-gene markers,which is the 21 gene relapse score(Oncotype DX,USA)and the 70 gene predictive marker(MammaPrint,Agendia,Amsterdam,Netherlands),which have shown level 1 clinical utility.The prognosis of patients receiving adjuvant endocrine therapy without chemotherapy can be identified.This paper presents a unified review of the development of MammaPrint gene detection system and the prospective clinical trial MINDACT,hoping to increase the understanding of it.