2018年11月28日，国际抗癌联盟《国际癌症杂志》在线发表荷兰综合癌症组织、特文特大学、格罗宁根大学、卡尼修斯·威廉敏娜医院、荷兰癌症研究所、多德雷赫特病理学实验室、马斯特里赫特大学、法国巴黎居里研究所的研究报告，分析了不同乳腺癌亚型与10年复发率和死亡率之间的相关性。
该研究对2005年荷兰全国癌症登记数据库所有诊断为浸润性非转移性乳腺癌的8062例已手术女性进行分析，根据雌激素受体、孕激素受体、HER2状态和分级将患者归入不同的乳腺癌亚型：管腔A型、管腔B型、HER2阳性和三阴性。对不同亚型的复发百分比和风险比进行比较。通过多因素比例风险回归模型，计算校正10年总生存和无复发生存。
结果，管腔A型4482例（56%）、管腔B型2090例（26%）、HER2阳性504例（6%）、三阴性986例（12%）。
局部复发和远处转移最多见于HER2阳性（7.5%和25.6%）、最少见于管腔A型（3.7%和9.5%）。
淋巴引流区域复发最多见于三阴性（5.2%）、最少见于管腔A型（1.7%）。
HER2阳性和三阴性亚型的第二年复发率最高，而管腔A型和管腔B型的乳腺小叶肿瘤复发逐年增多。
对基线特征差异进行校正后，三阴性的10年总生存较差，三阴性和HER2阳性的10年无复发生存率最低。
因此，该研究结果表明，乳腺癌亚型是10年复发和生存的重要预测因素。根据这些不同亚型对复发和生存的分析结果，结合其他预后因素，有助于对患者进行个体化治疗和随访。
Int J Cancer. 2018 Nov 28. [Epub ahead of print]
Ten-year recurrence rates for breast cancer subtypes in the Netherlands: A large population-based study.
van Maaren MC, de Munck L, Strobbe LJ, Sonke GS, Westenend PJ, Smidt ML, Poortmans PM, Siesling S.
Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; University of Twente, Enschede, the Netherlands; University of Groningen, Groningen, the Netherlands; Canisius Wilhelmina Hospital, Nijmegen, the Netherlands; Netherlands Cancer Institute, Amsterdam, the Netherlands; Laboratory of Pathology, Dordrecht, the Netherlands; Maastricht University Medical Centre, Maastricht, the Netherlands; Institut Curie, Paris, France.
While breast cancer subtypes are known independent predictors of survival and recurrence risk, data on long-term recurrences in daily practice remain scarce. In this population-based study reporting on 10-year recurrences, HER2 positive and triple negative subtypes showed the highest recurrence rates, which occurred most often in the second year, while luminal A and B recurred later on during the follow-up. Lobular tumours recurred more often than ductal tumours. In the Netherlands, breast cancer subtypes are thus important predictors for 10-year recurrence rates. Knowledge on recurrence and survival rates according to these different subtypes can help support patient-tailored treatment and individualised follow-up.
Here we report for the first time the relation between breast cancer subtypes and 10-year recurrence rates and mortality in the Netherlands. All operated women diagnosed with invasive non-metastatic breast cancer in 2005 in the Netherlands were included. Patients were classified into breast cancer subtypes according to ER, PR, HER2 status and grade: luminal A, luminal B, HER2 positive and triple negative. Percentages and hazards of recurrence were compared among subtypes. Adjusted 10-year overall (OS) and recurrence-free survival (RFS) were calculated using multivariable Cox regression. Of 8,062 patients, 4,482 (56%) were luminal A, 2,090 (26%) luminal B, 504 (6%) HER2 positive and 986 (12%) triple negative. Local recurrences (7.5%) and distant metastases (25.6%) occurred most often in HER2 positive disease and the least often in luminal A (3.7% and 9.5%, respectively). Regional recurrences were most often diagnosed in triple negative disease (5.2%), and the least often in luminal A (1.7%). HER2 positive and triple negative subtypes had the highest recurrence rates in the second year, while luminal A and B showed a more continuous pattern over time, with lobular tumours recurring more often. After adjustment for differences in baseline characteristics, triple negative disease showed worse 10-year OS and triple negative and HER2 positive disease had the lowest 10-year RFS. In the Netherlands, breast cancer subtypes are important predictors for 10-year recurrence rates. Knowledge on recurrence and survival rates according to these different subtypes, in combination with other prognostic factors, can support patient-tailored treatment and individualised follow-up.
KEYWORDS: 10-year follow-up; breast cancer; breast cancer subtypes; hazard; population-based; recurrence
PMID: 30368776
DOI: 10.1002/ijc.31914
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