乳腺癌特殊亚型患者复发风险悬殊

　　乳腺癌的特殊组织学亚型，包括乳头状癌、髓样癌、腺样囊性癌、黏液腺癌、大汗腺样癌、鳞状细胞癌等，被认为预后良好。

　　2018年8月9日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学年鉴》在线发表纽约纪念医院斯隆凯特林癌症中心的研究报告，通过21基因乳腺癌复发评分多基因检测，分析了特殊组织学亚型乳腺癌的不同预后，并且分析了更常见的导管癌和小叶癌复发评分分布。

　　该研究收集了2004年2月～2017年8月基因组健康临床实验室的61万350例肿瘤标本，患者年龄中位60岁（四分位距：51～67岁），淋巴结阴性占80%。根据苏木精伊红染色切片和世界卫生组织标准对标本组织学进行集中分类，比较组织学亚型的复发评分分布（<18分为低风险，18～30分为中风险，≥31分为高风险）。

　　结果发现，大多数患者（59.2%）复发评分低，仅少数（9.5%）复发评分高。乳头状癌的平均复发评分最低（11分），导管浸润癌的平均复发评分最高（18.4分）。所有特殊亚型患者的平均复发评分都低于导管浸润癌患者。当高复发评分阈值由31分降至被用于TAILORx和RxPONDER研究的25分时，高复发评分患者数量由9.5%增加至16.8%。小叶浸润癌患者的平均复发评分低于导管浸润癌患者，分别为16.5分和18.4分。

　　因此，被分类为特殊组织学亚型的乳腺癌患者预后存在很大差异，中复发评分占12%～25%，高复发评分占0.5%～9%。根据TAILORx和RxPONDER研究化疗对中复发评分患者作用的进一步定义，复发评分结果可能有助于这些患者的全身治疗决策。

Ann Surg Oncol. 2018 Aug 9. [Epub ahead of print]

Breast Cancers of Special Histologic Subtypes Are Biologically Diverse.

Audree B. Tadros, Hannah Y. Wen, Monica Morrow.

Memorial Sloan Kettering Cancer Center, New York, USA.

BACKGROUND/OBJECTIVE: Cancers classified as "special histologic subtypes" are felt to have a good prognosis. We used the 21-gene Oncotype DX Breast Recurrence Score multigene assay to examine prognostic variation within special histologic subtypes. We also examined the Recurrence Score (RS) distribution among the more common ductal (IDC) and lobular (ILC) cancers.

METHODS: 610,350 tumor specimens examined in the Genomic Health clinical laboratory from 2/2004 to 8/2017 were included. Specimen histology was classified centrally using a single H&E slide and World Health Organization criteria. RS distribution (low<18, intermediate 18-30, and high≥31) was compared among histologic subtypes.

RESULTS: Median patient age was 60 years (IQR 51-67); 80% were node negative. Most patients had low RS results (59.2%); only 9.5% had high results. The lowest mean RS was seen in the papillary subtype (11); the highest in the IDC group (18.4). Mean RS for all special subtypes was lower than that of IDC patients. When the high RS threshold was decreased from 31 to 25, as used in the TAILORx and RxPONDER trials, the number of high RS-result patients increased from 9.5% to 16.8%. Patients with ILC had a lower mean RS result than patients with IDC, 16.5 versus 18.4.

CONCLUSION: There is substantial diversity in predicted prognosis among patients with cancers classified as special histologic subtypes, with 12-25% having intermediate RS results and 0.5-9% having high RS results. Pending further definition of the role of chemotherapy for patients with intermediate RS results by TAILORx and RxPONDER, the RS result may help to inform systemic therapy decisions in these patients.

DOI: 10.1245/s10434-018-6687-z

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