ASO：香港中文大学谢文杰发现纤维化病灶为乳腺癌不良预后因素

在乳腺癌中可观察到纤维化病灶(FF)存在，有建议认为，纤维化病灶为一种重要的预后标志。然而，此类观察结果多由同一个研究组所报告，且研究针对的样本队列也存在类似性。因此，FF与分子学亚型以及与患者预后间的关系尚未得到厘清。对此，英国皇家内科医师学会会员、中国香港中文大学威尔士亲王医院的 Gary M. Tse(谢文杰)教授等人进行了研究，并在2013年3月29日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上发表了相关结果。

研究对象为450例乳腺癌患者，研究人员对患者FF与临床病理学参数及生物标记物间的关系进行了评价。

研究人员发现，在全部连续病例中，18.7 %的患者存在FF。FF与浸润性切缘存在正向关联(p = 0.03)，而与广泛的导管原位癌成分(p < 0.001)及淋巴结浸润(p < 0.001)间存在负向关联。FF与雌激素受体间存在正向关联(p = 0.007)，而与人表皮生长因子受体2 (HER2; p = 0.001)、表皮生长因子受体(p = 0.021)、Ki-67 (p = 0.001)以及c-kit (p = 0.009)间存在负向关联。根据观察，与上述结论并存的是，FF常出现于管状A亚型癌(p < 0.001)，而少见于管状B亚型癌(p = 0.045)及HER2过表达的乳腺癌类型(p = 0.011)中。针对患者结局(中位时间为41个月，范围为1-69 个月)的分析表明，FF为患者，尤其是管状B亚型患者无病生存期的不良预后因素(风险比= 2.57; 95 %置信区间= 1.267-5.214, p = 0.009)。

这项研究结果表明，FF与特定的浸润性、星型形态肿瘤存在关联(典型形式为浸润性导管癌–不另行说明)，而与存在大量淋巴结浸润的圆形、细胞团状肿瘤(基底样型乳腺癌)无关。因此可认为，FF为独立于其他不良预后因素的另一种不良预后因素。

与乳腺癌相关的拓展阅读：

• J Clin Oncol：侵润性小叶乳腺癌：曲妥单抗疗效如何？
• 侵润性小叶乳腺癌：曲妥单抗疗效如何？
• JCO：乳腺癌“AVEREL”临床试验的阴性结果
• ANN INTERN MED：乳腺癌的药物性预防
• Lancet Oncol述评：腋窝淋巴结清扫术或不影响哨兵淋巴结微转移乳腺癌患者的预后
• JCO：适量饮酒有利于乳腺癌女性患者生存 更多信息请点击：有关乳腺癌更多资讯

Fibrotic Focus in Breast Carcinomas: Relationship with Prognostic Parameters and Biomarkers.
BACKGROUND
Fibrotic focus (FF) has been observed in breast cancers and is suggested to be an important prognostic marker. However, most of these observations were reported by the same group of investigators with similar sample cohort. The relationship of FF and molecular subtypes as well as its associated prognosis has not been elucidated.
METHODS
In this study, 450 cases of breast carcinomas were evaluated for the presence of FF and its association with clinicopathologic parameters and biomarkers.
RESULTS
FF was found in 18.7 % of all consecutive cases. FF was associated positively with infiltrative margins (p = 0.03) but negatively with extensive in situ component (p < 0.001) and lymphocytic infiltration (p < 0.001). It was positively associated with estrogen receptor (p = 0.007) but negatively with human epidermal growth factor receptor 2 (HER2; p = 0.001), epidermal growth factor receptor (p = 0.021), Ki-67 (p = 0.001), and c-kit (p = 0.009). Concomitantly, FF was seen more commonly in luminal A cancers (p < 0.001) but less so in luminal B (p = 0.045) and HER2-overexpressing cancers (p = 0.011). Analysis on patient outcome (median 41 months, range 1-69 months) indicated that FF was an independent poor prognostic factor for disease-free survival (hazard ratio = 2.57; 95 % confidence interval = 1.267-5.214, p = 0.009), particularly in the luminal B subtype.
CONCLUSIONS
The findings suggested that FF is associated with specific tumor morphology of an infiltrative, stellate pattern (typical invasive ductal carcinoma-not otherwise specified) rather than round, cellular mass with intense lymphocytic infiltrate (basal-like breast cancers). The poor prognostic implication of FF is additional and independent of other adverse prognostic indicators.