21基因复发风险评分在乳腺黏液癌中的临床应用价值

doi:10.3969/j.issn.1673-8640.2021.07.007

摘要/Abstract

摘要：

目的探讨21基因复发风险评分在乳腺黏液癌（MBC）中的临床应用价值。方法选取接受手术治疗的96例雌激素受体（ER）阳性、人类表皮生长因子受体2（HER-2）阴性的MBC患者,收集所有患者的临床资料。提取所有患者肿瘤组织石蜡包埋标本中的RNA,采用实时荧光定量聚合酶链反应（PCR）检测21基因的表达,计算21基因复发风险评分,根据评分结果将所有患者分为低危组（<18分）、中危组（18~30分）和高危组（>30分）。采用多因素Logistic回归分析评估21基因复发风险评分的独立影响因素。采用Kaplan-Meier生存曲线评估无病生存期（DFS）。结果 96例MBC患者中低危组23例（24.0%）、中危组63例（65.6%）、高危组10例（10.4%）。低危组、中危组及高危组之间孕激素受体（PR）表达、分子分型及肿块大小差异均有统计学意义（P<0.05）,年龄、绝经时间、stage分期、Ki67表达差异均无统计学意义（P>0.05）。多因素Logistic回归分析结果显示,PR低表达是MBC患者21基因复发风险评分为高危的独立危险因素[比值比（OR）=7.271,95%可信区间（CI）为0.728~3.240]。化疗的选择与Ki67表达、分子分型、PR表达及21基因复发风险评分有关（P<0.05）,与年龄、肿块大小、绝经时间、手术方式、stage分期无关（P>0.05）。多因素Logistic回归分析结果显示,21基因复发风险评分及Ki67表达是选择化疗的独立影响因素（P<0.05）。Kaplan-Meier生存曲线分析结果显示,低危组、中危组及高危组之间DFS差异均无统计学意义（P>0.05）。结论在MBC患者中,21基因复发风险评分与PR表达密切相关,是辅助化疗选择的独立影响因素,但不能预测患者DFS的长短。

关键词: 21基因复发风险评分, 乳腺黏液癌, 临床病理特征, 辅助化疗

Abstract:

Objective To investigate the clinical value of 21-gene recurrence score（RS） in mucinous breast cancer（MBC）. Methods Totally,96 MBC patients with estrogen receptor（ER） positive and human epidermal growth factor receptor 2（HER-2） negative who underwent surgical treatment were enrolled,and the clinical data of all the patients were collected. RNA was extracted from the tumor paraffin specimens of patients. Real-time fluorescence quantitative polymerase chain reaction（PCR） was used to determine the expression of 21 genes,and 21-gene RS was calculated. According to the scores,all the patients were classified into low-risk group（<18 points）,intermediate-risk group（18-30 points）and high-risk group（>30 points）. Logistic regression was used to analyze the influence factors of 21-gene RS. Kaplan-Meier curve was used to assess disease-free survival（DFS）.Results Among the 96 patients with breast cancer,there were 23 patients（24.0%） in the low-risk group,63 patients（65.6%） in the intermediate-risk group and 10 patients（10.4%） in the high-risk group. There was statistical significance in progestin receptor（PR） expression,molecular typing and tumor size among the low-risk group,intermediate-risk group and high-risk group（P<0.05）. There was no statistical significance in age,menopausal time,staging and Ki67 expression（P>0.05）. Multivariate analysis demonstrated that PR status was independently associated with high risk based on 21-gene RS [odds ratio（OR）=7.271,95% confidence interval（CI） 0.728-3.240]. Univariate analysis found that the choice of chemotherapy was related to Ki67 expression,molecular typing,PR expression and 21-gene RS（P<0.05）．There was no correlation in age,tumor size,menopausal time,operation method and staging（P>0.05）. Multivariate analysis showed that Ki67 expression and 21-gene RS independently influenced the use of chemotherapy（P<0.05）. No statistical significance in DFS was found among MBC patients in different 21-gene RS subgroups（P>0.05）.Conclusions 21-Gene RS is related to PR status in MBC patients. 21-Gene RS does independently affect the choice of chemotherapy. However,21-gene RS is not able to predict DFS in MBC patients.

Key words: 21-Gene recurrence score, Mucinous breast cancer, Clinicopathologic characteristic, Adjuvant chemotherapy

中图分类号:

R446.1

林佳菲, 陈小松, 吴蓓颖, 蔡刚, 林琳. 21基因复发风险评分在乳腺黏液癌中的临床应用价值[J]. 检验医学, 2021, 36(7): 714-718.

LIN Jiafei, CHEN Xiaosong, WU Beiying, CAI Gang, LIN Lin. 21-Gene recurrence score in mucinous breast cancer[J]. Laboratory Medicine, 2021, 36(7): 714-718.

图/表 4

参考文献 13

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组别	例数	年龄			肿块大小				月经状态			手术方式
组别	例数	<50岁	≥50岁		≤2 cm	>2 cm			绝经前	绝经后		保乳		乳房切除
低危组	23	6	17		8	15			8	15		9		14
中危组	63	21	42		40	23			23	40		35		28
高危组	10	4	6		4	6			4	6		6		4
χ²值		0.708			6.496				0.082			2.102
P值		0.702			0.039				0.960			0.350
组别	分子分型						stage分期			PR			Ki67
组别	Luminal A型			Luminal B型			Ⅰ期	Ⅱ期		<20%	≥20%		<14%		≥14%
低危组	9			14			8	15		3	20		12		11
中危组	30			33			39	24		13	50		39		24
高危组	0			10			4	6		8	2		4		6
χ²值	8.141						5.749			18.527			2.016
P值	0.017						0.056			<0.001			0.365

组别	例数	年龄			肿块大小				月经状态			手术方式
组别	例数	<50岁	≥50岁		≤2 cm	>2 cm			绝经前	绝经后		保乳		乳房切除
低危组	23	6	17		8	15			8	15		9		14
中危组	63	21	42		40	23			23	40		35		28
高危组	10	4	6		4	6			4	6		6		4
χ²值		0.708			6.496				0.082			2.102
P值		0.702			0.039				0.960			0.350
组别	分子分型						stage分期			PR			Ki67
组别	Luminal A型			Luminal B型			Ⅰ期	Ⅱ期		<20%	≥20%		<14%		≥14%
低危组	9			14			8	15		3	20		12		11
中危组	30			33			39	24		13	50		39		24
高危组	0			10			4	6		8	2		4		6
χ²值	8.141						5.749			18.527			2.016
P值	0.017						0.056			<0.001			0.365

组别	例数	年龄				肿块大小						月经状态					手术方式
组别	例数	<50		≥ 50		≤ 2 cm		>2 cm				绝经前		绝经后			保乳			乳房切除
不化疗	81	25		56		42		39				29		52			42			39
化疗	15	6		9		10		5				6		9			8			7
χ²值		0.483			1.119					0.096						0.011
P值		0.487			0.290					0.756						0.916
组别	分子分型						21基因复发风险评估						PR					Ki67			stage分期
组别	Luminal A型		Luminal B型				低危组		中危组		高危组		<20%		≥ 20%			<14%	≥14%		I	II
不化疗	38		43				22		56		3		15		66			52	29		42	39
化疗	1		14				1		7		7		9		6			3	12		9	6
χ²值	8.499								25.619				11.615					10.104			0.337
P值	0.004								< 0.001				0.001					0.001			0.561

组别	例数	年龄				肿块大小						月经状态					手术方式
组别	例数	<50		≥ 50		≤ 2 cm		>2 cm				绝经前		绝经后			保乳			乳房切除
不化疗	81	25		56		42		39				29		52			42			39
化疗	15	6		9		10		5				6		9			8			7
χ²值		0.483			1.119					0.096						0.011
P值		0.487			0.290					0.756						0.916
组别	分子分型						21基因复发风险评估						PR					Ki67			stage分期
组别	Luminal A型		Luminal B型				低危组		中危组		高危组		<20%		≥ 20%			<14%	≥14%		I	II
不化疗	38		43				22		56		3		15		66			52	29		42	39
化疗	1		14				1		7		7		9		6			3	12		9	6
χ²值	8.499								25.619				11.615					10.104			0.337
P值	0.004								< 0.001				0.001					0.001			0.561

项目	OR值（95%CI）	P值
21基因复发风险评分		0.018
低危	1
中危	2.978（0.314~28.278）	0.342
高危	36.694（2.411~653.509）	0.010
Ki67		0.019
<14%	1
≥14%	10.624（1.480~76.289）
PR		0.142
<20%	1
≥20%	0.315（0.067~1.471）
分子分型		0.948
Luminal A型	1
Luminal B型	1.093（0.078~15.358）