21基因复发风险评分在乳腺癌患者中的应用  

Application of 21-gene recurrence risk score in patients with breast cancer

作　　者：陈青 沈海幸[2] 王艳丽[1] 赵菁[1] 马巾斐 王淑倩[3] 傅佩芬[3] Chen Qing;Shen Haixing;Wang Yanli;Zhao Jing;Ma Jinfei;Wang Shuqian;Fu Peifen(Department of Pathology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Breast and Thyroid Surgery,Cixi People′s Hospital,Zhejiang Province,Cixi 315300,China;Department of Breast Surgery,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院病理科,杭州310003 [2]浙江省慈溪市人民医院甲乳外科,慈溪315300 [3]浙江大学医学院附属第一医院乳腺外科,杭州310003

出　　处：《中华病理学杂志》2024年第7期678-684,共7页Chinese Journal of Pathology

摘　　要：目的探讨激素受体阳性、HER2阴性、未接受新辅助治疗的早期乳腺癌患者21基因复发风险评分(21-gene recurrence risk score,21-Gene RS)与患者预后及临床病理特征的关系。方法收集浙江大学医学院附属第一医院2014年1月至2017年10月接受手术治疗的早期激素受体阳性、HER2阴性乳腺癌患者469例,回顾性分析其临床病理资料。收集患者的肿瘤组织标本,进行即时荧光定量逆转录聚合酶链反应(RT-qPCR)检测21基因的表达,计算21-Gene RS并基于个体化治疗方案分配试验(Trial Assigning Individualized Options for Treatment,TAILORx)分组及国家乳腺和肠道外科辅助治疗项目(National Surgical Adjuvant Breast and Bowel Project B-20,NSABP B-20)分组原则,将患者分为低(21-Gene RS<11或21-Gene RS<18)、中(11≤21-Gene RS<26或18≤21-Gene RS<31)和高危组(21-Gene RS≥26或21-Gene RS≥31),比较不同风险分组患者的临床病理特征和预后差别。使用卡方检验比较计数资料,Kaplan-Meier曲线分析进行生存分析,Log-rank检验方法进行组间差异比较,COX回归分析进行多因素分析。结果469例乳腺癌患者,基于TAILORx RS分组,低危组比例为18.8%(88/469),中危组比例为48.2%(226/469),高危组比例为33.0%(155/469)。基于NSABP B-20 RS分组,低危组比例为43.1%(202/469),中危组比例为37.5%(176/469),高危组比例为19.4%(91/469)。无论使用TAILORx RS分组还是NSABP B-20 RS分组,21-Gene RS与患者的组织学分级、Luminal分型、Ki-67表达以及是否接受化疗和治疗方式的关联均有统计学意义(P<0.05)。Kaplan-Meier生存分析提示高危组患者预后较差(P<0.05,Log-rank检验)。多因素COX回归分析结果表明手术方式和21-Gene RS是影响患者预后的风险因素。结论21-Gene RS与激素受体阳性、HER2阴性、未接受新辅助治疗的早期乳腺癌患者的预后以及患者的组织学分级、Luminal分型、Ki-67表达以及是否接受化疗和治疗方式等临床病理特征Objective To investigate the relationship between 21-gene recurrence risk score(21-Gene RS)and the prognosis and clinicopathological features of hormone receptor(HR)positive,HER2-negative early breast cancer patients who did not receive neoadjuvant therapy.Methods A total of 469 patients with HR positive and HER2-negative early breast cancer who received surgical treatment in the First Affiliated Hospital,Zhejiang University School of Medicine from January 2014 to October 2017 were selected.Their clinicopathological data were retrospectively analyzed.Tumor tissue samples were collected from patients,and the expression of 21-gene was detected by reverse transcription quantitative real-time polymerase chain reaction(RT-qPCR).The 21-Gene RS was calculated according to the Trial Assigning Individualized Options for Treatment(TAILORx)RS grouping and National Surgical Adjuvant Breast and Bowel Project B-20(NSABP B-20)RS grouping principles.Patients were divided into low(21-Gene RS<11 or 21-Gene RS<18),intermediate(11≤21-Gene RS<26 or 18≤21-Gene RS<31)and high(21-Gene RS≥26 or 21-Gene RS≥31)risk groups,and the clinicopathological features and prognostic differences of patients in different risk groups were compared.Statistical data were compared by chi-square test.Survival analysis was performed using Kaplan-Meier curve analysis and the differences between groups were compared using Log-rank test.Multivariate analysis was conducted by COX regression analysis.Results Based on TAILORx RS grouping,the proportions of low-risk,intermediate-risk and high-risk groups among the 469 patients were 18.8%(88/469),48.2%(226/469)and 33.0%(155/469),respectively.Based on NSABP B-20 RS grouping,the proportion of low-risk,intermediate-risk and high-risk groups were 43.1%(202/469),37.5%(176/469)and 19.4%(91/469),respectively.The association of 21-Gene RS with histological grading,luminal typing,Ki-67 expression,and chemotherapy and treatment modalities were statistically significant(P<0.05)regardless of TAILORx RS grouping or NSAB

关 键 词：乳腺肿瘤 预后 21基因复发风险评分 

分 类 号：R737.9[医药卫生—肿瘤]