小知识:乳腺癌21基因检测

2015-05-26 MedSci MedSci原创

2007年美国临床肿瘤学会(ASCO)公布乳腺癌治疗方案制定过程中应该考虑为雌激素受体呈阳性、淋巴结未扩散的早期乳腺癌患者进行乳腺癌21基因检测。美国国家癌症联合中心系统 (NCCN)在 2008年乳腺癌治疗指南中,建议使用乳腺癌21基因检测。2011 St. Gallen会议对于乳腺癌分子亚型的定义中,绝大部分专家团成员对于Luminal B(HER2-)同意对于经过其他检测后仍存在不确定性的内

2007年美国临床肿瘤学会(ASCO)公布乳腺癌治疗方案制定过程中应该考虑为雌激素受体呈阳性、淋巴结未扩散的早期乳腺癌患者进行乳腺癌21基因检测。美国国家癌症联合中心系统 (NCCN)在 2008年乳腺癌治疗指南中,建议使用乳腺癌21基因检测。

2011 St. Gallen会议对于乳腺癌分子亚型的定义中,绝大部分专家团成员对于Luminal B(HER2-)同意对于经过其他检测后仍存在不确定性的内分泌敏感患者,应使用21-基因标记(Oncotype DX)来预测化疗的疗效。NCCN2011指南中,对于ER+/HER2-患者的化疗指征评定需要结合21基因检测来判断。2013 St. Gallen会议共识中,对于LuminalA型乳腺癌中,如果21基因评估高RS的患者需要化疗。乳腺癌21基因检测已经成为乳腺癌研究中一个热点。

一、什么是『乳腺癌21基因检测』?

肿瘤基因的调节通过基因表达(转录和翻译)来完成。基因表达模式包括基因的正向调节和负向调节,它决定着其相关蛋白的表达量。『乳腺癌21基因检测』检测恶性肿瘤组织中一组特异基因的表达,对预测预后、复发、瘤灶转移乃至指导治疗提供信息,最终目的是为患者的个体化治疗提供帮助。多参数基因表达试验同时检测多种肿瘤基因的表达产物。结果以积分的形式表示,积分用于对肿瘤可能发生的生物学行为的预测。『乳腺癌21基因检测』是指检测乳腺癌肿瘤组织中21个不同基因的表达水平,包含16个乳腺癌相关基因和5个参考基因(如图1),这个检测能够提供个体化的治疗效果预测和10年复发风险的预测。通过检测检测21个基因,观察他们之间的相互作用来判断肿瘤特性,从而可预测乳腺癌复发指数以及接受化疗的效益比。

图1. 乳腺癌21基因检测的基因分为6组:增殖组、侵袭组、HER-2组、雌激素组、其它基因组、参照基因组。

二、『乳腺癌21基因检测』能带来何种益处

1、提供个体化化基因检测结果

每个肿瘤患者都是独一无二的,都具有特性,没有完全一样的,因此每个乳腺肿瘤患者复发指数及治疗方式也是不同的,『乳腺癌21基因检测』属于基因组学(genomics)。通过检测乳腺肿瘤中21个基因,观看它们之间的相互作用来判断肿瘤特性,从而可预测个体化的乳腺肿瘤复发指数以及接受化疗的效益比。

2、辅助制定乳腺癌的治疗方案

乳腺癌21基因检测提供更精确的资料让医生和病患更进一步了解肿瘤状况,有助于医生作出更精确的治疗判断。检测报告中的复发指数 (RS) ,是一个介于0到100 之间的数字,患者的复发指数越低,乳腺癌复发的机率也就越低,同时预示患者越不容易在化疗中获益,因此,医生可能建议这部分患者只需使用激素治疗。但低复发指数并不表示乳腺癌就不会复发;患者的复发指数越高,乳腺癌复发的机率越高。虽然这令人很沮丧,但好处是这些患者在化疗中获益的机率也同时增高,因此在激素治疗外需加以化疗,将有助于这类患者降低乳腺癌复发的概率。同样的,高复发指数也不一定代表示乳腺癌就一定复发。检测报告中也会有ER、PR、Her2组指数,使医生更加了解病患的肿瘤特性。

3、改善癌症个案管理计划

无论是低复发指数或是高复发指数,『乳腺癌21基因检测』结果都可以进一步地协助拟订个体化的癌症康复管理计划。假设一个检测结果为高复发指数的患者,意味该患者再度复发且转移的概率相较于低复发或中复发指数者为高,因此在手术后不仅仅需要接受化疗和激素治疗,更需要提高癌症治疗管理等级(如定期做相关的检查、接受专业营养师的饮食建议等) 。

4、避免治疗上处理不足或治疗上过度处理等状况

化疗是治疗有效的一种手段,但是并不是所有的患者都适用化疗,有时无谓的化疗甚至会加重患者的病情。

三、『乳腺癌21基因检测』适合哪些人?

处于I或 II期、雌激素受体阳性、淋巴结转移阴性、将要采用他莫昔芬治疗的新确诊乳腺癌患者。绝经后,淋巴结阳性、雌激素受体阳性的侵润性乳腺癌患者,也可以通过21基因检测确定化疗获益。

四、『乳腺癌21基因检测』结果及判定

检测结果为“复发风险评分”,分值为0-100分。<18分为复发低危;18-30为复发中危;>31为复发高危。复发高危的患者采用辅助性化疗更有效。

判读标准:(1)RS<18,复发风险较低,请谨慎选择化疗; (2)1831,复发风险较高,化疗获益较大。

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    2017-02-10 cxdsnow

    我们公司可以做这项检测,需要可以联系我:18550010105陈经理

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    2016-08-27 李东泽

    这篇资讯带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=175420, encodeId=19111e542089, content=我们公司可以做这项检测,需要可以联系我:18550010105陈经理, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fe66101089, createdName=cxdsnow, createdTime=Fri Feb 10 20:05:33 CST 2017, time=2017-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=105990, encodeId=30d4105990ce, content=这篇资讯带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sat Aug 27 22:42:00 CST 2016, time=2016-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1705963, encodeId=39721e05963da, content=<a href='/topic/show?id=a5974e07032' target=_blank style='color:#2F92EE;'>#小知识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47070, encryptionId=a5974e07032, topicName=小知识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a05c31113052, createdName=spoonycyy, createdTime=Sat Feb 13 07:03:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2049738, encodeId=f0632049e38ab, content=<a href='/topic/show?id=542a984fa' target=_blank style='color:#2F92EE;'>#21基因检测#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=984, encryptionId=542a984fa, topicName=21基因检测)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Mon Oct 26 19:03:00 CST 2015, time=2015-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30720, encodeId=f23330e2044, content=不错不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a6a1604604, createdName=Gsurgeon, createdTime=Sat Jul 04 23:39:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25623, encodeId=5f6e2562384, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:33:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25071, encodeId=afd8250e1cd, content=学习,希望对自己的领域有帮助~, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160515/IMG57380B859AD1F1019.jpg, createdBy=2c5c1621956, createdName=jasonuclear, createdTime=Wed May 27 08:35:00 CST 2015, time=2015-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25041, encodeId=2dde25041f2, content=。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c08106028, createdName=alicelee, createdTime=Tue May 26 23:47:00 CST 2015, time=2015-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25035, encodeId=b65b25035b8, content=涨知识了,有助于知道乳腺癌的个体化治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19311619842, createdName=xcjick, createdTime=Tue May 26 23:36:00 CST 2015, time=2015-05-26, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=175420, encodeId=19111e542089, content=我们公司可以做这项检测,需要可以联系我:18550010105陈经理, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fe66101089, createdName=cxdsnow, createdTime=Fri Feb 10 20:05:33 CST 2017, time=2017-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=105990, encodeId=30d4105990ce, content=这篇资讯带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sat Aug 27 22:42:00 CST 2016, time=2016-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1705963, encodeId=39721e05963da, content=<a href='/topic/show?id=a5974e07032' target=_blank style='color:#2F92EE;'>#小知识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47070, encryptionId=a5974e07032, topicName=小知识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a05c31113052, createdName=spoonycyy, createdTime=Sat Feb 13 07:03:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2049738, encodeId=f0632049e38ab, content=<a href='/topic/show?id=542a984fa' target=_blank style='color:#2F92EE;'>#21基因检测#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=984, encryptionId=542a984fa, topicName=21基因检测)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=743d308, createdName=baoya, createdTime=Mon Oct 26 19:03:00 CST 2015, time=2015-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30720, encodeId=f23330e2044, content=不错不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a6a1604604, createdName=Gsurgeon, createdTime=Sat Jul 04 23:39:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25623, encodeId=5f6e2562384, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:33:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25071, encodeId=afd8250e1cd, content=学习,希望对自己的领域有帮助~, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160515/IMG57380B859AD1F1019.jpg, createdBy=2c5c1621956, createdName=jasonuclear, createdTime=Wed May 27 08:35:00 CST 2015, time=2015-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25041, encodeId=2dde25041f2, content=。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c08106028, createdName=alicelee, createdTime=Tue May 26 23:47:00 CST 2015, time=2015-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25035, encodeId=b65b25035b8, content=涨知识了,有助于知道乳腺癌的个体化治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19311619842, createdName=xcjick, createdTime=Tue May 26 23:36:00 CST 2015, time=2015-05-26, status=1, ipAttribution=)]
    2015-07-04 Gsurgeon

    不错不错

    0

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    2015-05-31 huaxipanxing

    看看

    0

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    2015-05-27 jasonuclear

    学习,希望对自己的领域有帮助~

    0

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    2015-05-26 alicelee

    0

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    2015-05-26 xcjick

    涨知识了,有助于知道乳腺癌的个体化治疗。

    0

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