三阴性乳腺癌大数据：分子学分型新时代，组织学分型是否仍有临床意义
乳腺癌已经进入分子学分型的新时代，那么组织学分型是否仍有临床意义？
2018年1月9日，欧洲肿瘤外科学会和英国肿瘤外科学会《欧洲肿瘤外科杂志》在线发表复旦大学附属肿瘤医院和肿瘤研究所以及上海医学院与生物医学研究院赵珅、马丁、肖毅、江一舟、邵志敏的大数据分析报告，探讨了三阴性乳腺癌（TNBC）不同组织学分型的临床病理学特征和生存结局。
该大数据分析根据美国癌症研究所监测流行病学最终结果（SEER）数据库从21126例患者筛选出2010～2014年诊断为三阴性乳腺癌19828例，对其中最多的7种组织学分型进行分析，并以导管浸润癌为对照，与其他6种分型进行比较。
结果发现：
导管浸润癌：18152例（91.5%）ICD-O-3 8500/3
腺鳞化生癌：626例（3.2%）ICD-O-3 8560/3、8570/3、8571/3、8572/3、8575/3、8980/3
乳腺髓样癌：295例（1.5%）ICD-O-3 8510/3
混合浸润癌：237例（1.2%）ICD-O-3 8522/3
小叶浸润癌：201例（1.0%）ICD-O-3 8520/3
大汗腺型癌：195例（1.0%）ICD-O-3 8401/3
腺样囊性癌：122例（0.6%）ICD-O-3 8200/3
ICD-O-3 SEER Site/Histology Validation List
Released 09/18/2015 - updated from 2/9/2001
seer.cancer.gov/icd-o-3
诊断时年龄、肿瘤分级、大小、淋巴结状态、治疗可见显著差异。
随着肿瘤大小增加，小叶浸润癌和混合浸润癌的阳性淋巴结数量显著增加，而腺鳞化生癌仅少量增加。
根据多变量生存分析，与导管浸润癌相比：
混合浸润癌：
癌死亡风险高1.81倍（P<0.001）
总死亡风险高1.56倍（P=0.005）
腺鳞化生癌：
癌死亡风险高1.95倍（P<0.001）
总死亡风险高1.73倍（P<0.001）
乳腺髓样癌：
癌死亡风险低0.40倍（P=0.010）
大汗腺型癌：
癌死亡风险低0.27倍（P=0.008）
根据与时间相关的接受者操作特征（ROC）曲线分析，不同组织学分型TNM分期对于预后的意义：
小叶浸润癌：N分期优于T分期
腺鳞化生癌：T分期优于N分期
因此，根据三阴性乳腺癌的组织学分型，该疾病存在不同的临床病理学特征和预后。在乳腺癌分子学分型的新时代，三阴性乳腺癌的组织学分型仍有一定临床意义。
Eur J Surg Oncol. 2018 Jan 9. [Epub ahead of print]
Clinicopathologic features and prognoses of different histologic types of triple-negative breast cancer: A large population-based analysis.
Shen Zhao, Ding Ma, Yi Xiao, Yi-Zhou Jiang, Zhi-Ming Shao.
Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, PR China; Shanghai Medical College, Fudan University, PR China; Institute of Biomedical Sciences, Fudan University, Shanghai, PR China.
PURPOSE: To examine the clinicopathologic characteristics and survival outcomes of different histologic types of triple-negative breast cancer (TNBC).
METHODS: We used the SEER database to identify patients with TNBC diagnosed between 2010 and 2014. Our analysis focused on the seven most prevalent histologic types. Differences were compared between invasive carcinoma of no special type (NST) and the other six types.
RESULTS: Significant differences were observed in age at diagnosis, tumor grade, size, nodal status and treatment. As tumor size increased, the number of positive lymph nodes increased markedly in invasive lobular carcinoma (ILC) and mixed NST and lobular carcinoma (NST-ILC), while in metaplastic carcinoma the number only increased slightly. In multivariate survival analyses, compared with patients with invasive carcinoma NST, breast cancer-specific survival (BCSS) and overall survival (OS) were worse for those with NST-ILC (BCSS: hazard ratio [HR] 1.81, P < 0.001; OS: HR 1.56, P = 0.005) or metaplastic carcinoma (BCSS: HR 1.95, P < 0.001; OS: HR 1.73, P < 0.001). By contrast, patients with medullary (HR 0.40, P = 0.010) or apocrine carcinoma (HR 0.27, P = 0.008) showed better BCSS. Time-dependent receiver operating characteristic (ROC) analyses indicated that T category in ILC and N category in metaplastic carcinoma were of less prognostic value.
CONCLUSIONS: According to the histologic classification of TNBC, this heterogeneous disease can be divided into several entities with different clinicopathologic features and prognoses. In the era of molecular subtyping of breast cancer, the histologic classification of TNBC is still of considerable clinical significance.
KEYWORDS: triple-negative breast cancer; histologic type; clinicopathologic characteristics; prognosis
DOI: 10.1016/j.ejso.2017.11.027