2019年，中国学者对大样本三阴性乳腺癌患者的全部脱氧核糖核酸DNA基因信息、全部核糖核酸RNA转录信息及其临床数据进行全面分析，将三阴性乳腺癌进一步分为四种新的分子亚型：免疫调节亚型、雄激素受体管腔亚型、间充质样亚型、基底样免疫抑制亚型，各个亚型的临床意义和治疗策略各不相同。不过，并非任何医院都有条件进行基因转录分析，可是绝大多数医院都有条件进行超声检查，故有必要对三阴性乳腺癌新分型的超声表现进行分析。
2020年4月，AME出版社旗下《转化医学志》正式发表复旦大学附属肿瘤医院李佳伟、李娜、江一舟、刘依熔、时兆婷、常才、邵志敏等学者的研究报告，根据全部RNA转录信息，探讨了三阴性乳腺浸润癌各种超声特征、分子亚型特征以及临床病理特征对患者生存结局的预后意义。
该单中心回顾研究对2010年1月1日～2013年12月31日复旦大学附属肿瘤医院114例三阴性乳腺癌患者进行回顾分析。根据全部RNA转录特征，确定了四种亚型：免疫调节亚型、雄激素受体管腔亚型、间充质样亚型、基底样免疫抑制亚型。由两位超声医师根据乳腺成像报告数据系统BI-RADS对超声图像进行复核。通过多因素比例风险回归模型，确定无复发生存、总生存的影响因素。
结果，其中免疫调节亚型21例、雄激素受体管腔亚型18例、间充质样亚型36例，基底样免疫抑制亚型39例。四种分子亚型乳腺癌的肿瘤形状和后方回声改变显著不同（P=0.008、0.028）。
免疫调节亚型、基底样免疫抑制亚型与雄激素受体管腔亚型和间充质样亚型相比，形状规则、边缘光滑、后方回声增强等类似良性肿瘤的超声特征比例显著较高（P<0.05）。
根据多因素比例风险回归模型分析，无论其他影响因素如何，无复发生存和总生存的独立风险因素：
腋窝淋巴结转移（P<0.05）
基底样免疫抑制亚型（P<0.05）
基底样免疫抑制亚型与其他亚型相比，总生存显著较差（对数秩P=0.05）。
具有类似良性肿瘤超声特征的三阴性乳腺浸润癌患者死亡比例较低（3.3%比15.2%，P=0.088）。
因此，该研究结果表明，三阴性乳腺浸润癌超声表现与新的基因转录分子亚型密切相关，并且与患者生存结局具有一定相关性，可能有助于没有条件进行基因转录分析的基层医院对三阴性乳腺癌初步分型和预后，故有必要开展多中心大样本前瞻临床研究进行验证。
相关链接
Ann Transl Med. 2020 Apr;8(7):435.
Ultrasonographic appearance of triple-negative invasive breast carcinoma is associated with novel molecular subtypes based on transcriptomic analysis.
Li JW, Li N, Jiang YZ, Liu YR, Shi ZT, Chang C, Shao ZM.
Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.
BACKGROUND: Various sonographic features of triple-negative invasive breast carcinomas (TNBC) expected to be associated with the molecular subtypes based on transcriptomic analysis were examined. The effects of clinical, sonographic, pathological, and molecular features on survival outcome was also studied.
METHODS: One hundred and fourteen patients with breast cancer with negative expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal receptor 2 (HER2) were included in our retrospective study. Based on the transcriptomic profiles, four stable clusters named immunomodulatory (IM), luminal androgen receptor (LAR), mesenchymal-like (MES), and basal-like and immune-suppressed (BLIS) were identified. Ultrasound (US) images were reviewed by two US physicians according to Breast Imaging Reporting and Data System (BI-RADS). Multivariate Cox regression was used to determine the variables associated with recurrence-free survival (RFS) and overall survival (OS).
RESULTS: There were 21 IM, 18 LAR, 36 MES, and 39 BLIS cases. The four molecular subtypes showed significant differences in terms of tumor shape (P=0.008) and posterior acoustic pattern (P=0.028). Compared with the subtypes LAR and MES, the IM and BLIS subtypes had higher probability of presenting benign-like sonographic features, such as regular shape, no angular/spiculated margin, and posterior acoustic enhancement (P<0.05). The independent risk factors for RFS events and death were axillary lymph node metastasis (P<0.05) and BLIS subtype (P<0.05). BLIS subtype showed worse OS than other subtypes (log rank P=0.05). TNBCs with benign sonographic features tended to have less death events (3.3% vs. 15.2%, P=0.088).
CONCLUSIONS: Sonographic appearance of TNBCs is associated with transcriptome-based molecular subtypes, and tends to correlate with the survival outcome.
KEYWORDS: Triple-negative breast cancer (TNBC); long non-coding RNA (IncRNA); messenger RNA; molecular typing; ultrasonography
PMID: 32395479
PMCID: PMC7210204
DOI: 10.21037/atm.2020.03.204
联系客服
