21基因检测复发风险评分对激素受体阳性早期乳腺癌的治疗决策导向分析(附29例病例数据分析)  

The utility of 21-gene recurrence score assay in treatment decisions for women with hormonalreceptor positive early breast cancer

作　　者：关健华[1] 周毅[1] 林小佳[1] 黄文俊[1] 刘仁斌[2] 

机构地区：[1]江门市中心医院普通外科一区,广东江门529000 [2]中山大学附属第三医院甲状腺乳腺外科,广州510650

出　　处：《岭南现代临床外科》2017年第3期305-309,共5页Lingnan Modern Clinics in Surgery

基　　金：江门市科技计划项目(2016020200640002989)

摘　　要：目的初步分析21基因检测复发风险评分(recurrence score?,RS)对激素受体阳性早期乳腺癌的治疗决策导向作用。方法 2016年1月至2017年1月于江门市中心医院普通外科住院并行手术治疗的激素受体阳性早期乳腺癌患者29例,按照21基因检测复发风险评分结果分成低危组与中/高危组,比较其临床病理特征及评分前后的治疗决策。结果在患者的临床特征与RS复发分数的关联性分析中提示,复发风险分组与年龄、绝经状态、肿瘤直径、病理组织学分级及脉管癌栓等均无明显相关,而与Ki-67的表达(P=0.027)有关。在行21基因检测前,共有18例(62.0%)患者推荐内分泌治疗联合辅助化疗;公布RS复发分数后,11例(37.9%)患者被推荐改变为单纯内分泌治疗,7例(24.1%)患者仍建议行辅助化疗(Mc Nemar’s test,P=0.001)。结论对于激素受体阳性早期乳腺癌患者,增加21基因检测并计算复发风险评分能显著改变治疗决策,降低不必要的辅助化疗的比例。Objective To analyses the utility of 21-gene recurrence score assay in treatmentdecisions for women with hormonal-receptor positive(HR+)and HER2-early breast cancer(EBC).Methods A total of 29 female patients with HR+ EBC who had been hospitalized in Jiangmen CentralHospital,from January 2016 to January 2017,were divided into low risk group and intermediate/highrisk group according to the recurrence score. The general clinical pathological characteristics andthe treatment recommendations before and after 21-gene recurrence score assay in each groupswere compared. Results Association analysis showed that recurrence score was no relative with ages,menopausal status,tumor size,histopathological grade and vascular invasion,but significantly associativewith Ki-67(P=0.027). About 18 patients(62.0%)recommended endocrine therapy combined withadjuvant chemotherapy before 21-gene recurrence score assay. The proportion of patients recommendedchemotherapy decreased from 62.0% pretest to 24.1% post-test(Mc Nemars test,P=0.001). 11 patients(37.9%)changed treatment decisions to endocrine therapy alone. Conclusion Using 21-gene recurrencescore assay can significantly change treatment decisions and make an overall reduction in chemotherapyuse in women with hormonal-receptor positive early breast cancer.

关 键 词：早期乳腺癌 激素受体阳性 21基因 复发风险评分 治疗决策 

分 类 号：R737.9[医药卫生—肿瘤]