早期乳腺癌中70基因检测相关影响因素及应用现状的多中心观察性研究

Relevant influencing factors and application status of MammaPrint in early-stage breast cancer:A muti-center observational study

目的基因检测是乳腺癌预后评估的重要工具,对70基因检测(MammaPrint)在江苏省内28所三级医院早期乳腺癌中的应用现状进行调查,探究其相关影响因素及对辅助治疗方案选择的影响。方法横断面收集2019年5月至2023年3月于多中心接受MammaPrint女性乳腺癌患者的临床信息及病理资料,进行临床风险评估及基因风险评估,并记录治疗方案。结果组织学分级、Ki67表达(P<0.01)在MammaPrint各风险分组中存在显著性差异,而年龄、淋巴结状态的组间差异无统计学意义,进一步将以上自变量纳入Logistic回归分析,得到G3、Ki67≥10%为基因高风险的主要危险因素(P<0.05)。治疗方案选择上,89.5%的患者能够接受MINDACT临床研究的指导意见,10.9%的临床低风险人群治疗方案发生改变。同时需要注意,联合BluePrint检测后发现基因高风险人群中存在个例Basal型及HER2型乳腺癌。结论目前国内对于早期乳腺癌患者的辅助治疗决策总体较为保守,但MammaPrint评分在不同组织学分级、Ki67之间存在显著差异,可以考虑通过基因检测为对应人群指导降阶或升阶治疗。

Objective The genomic test is a significant instrument for the prognostic assessment of breast cancer.This study investigated the current application status of the MammaPrint in early-stage breast cancer in 28 tertiary hospitals in Jiangsu Province,to explore its relevant influencing factors,and to examine its impact on the selection of adjuvant treatment strategies.Methods A cross-sectional approach was used to collect clinical information and pathological data from female breast cancer patients who underwent MammaPrint at multiple centers from May 2019 to March 2023.Their clinical risk and genomic risk were determined,and treatment strategies were documented.Results Histological grade and Ki67(P<0.01)were significantly different in distinct gene risk groups,whereas there were no significant differences in these groups for such variables as age and lymph node status.Further including these variables in logistic regression analysis,G3 as well as Ki67≥10%were confirmed to be the main risk factors for high genomic risk(P<0.05).Regarding treatment approaches,89.5%of patients were able to adhere to the recommendations from the MINDACT trial,and 10.9%of low-clinical-risk individuals had changes in their treatment plans.In addition,it's necessary to note that by integrating MammaPrint with BluePrint,individual cases of Basal-type and HER2-type breast cancer were identified within the high genomic risk group.Conclusions Currently,adjuvant treatment decisions for early-stage breast cancer patients in China tend to be conservative.However,MammaPrint scores exhibit significant differences in distinct histological grades and Ki67 status.Therefore,MammaPrint could be considered to direct the de-escalation or escalation of therapies for particular patient groups.