孕激素受体与Ki-67指数组合对激素受体阳性中分化早期乳腺癌预后的评估价值

张燕娜; 周易冬; 茅枫; 姚儒; 孙强

doi:10.3969/j.issn.1674-9081.2019.05.019

孕激素受体与Ki-67指数组合对激素受体阳性中分化早期乳腺癌预后的评估价值

Prognostic Value of Progesterone Receptor and Ki-67 Combination in Hormone Receptor Positive Grade 2 Early-stage Breast Cancer

摘要

摘要:
目的探讨孕激素受体(progesterone receptor, PR)及Ki-67指数(PK)组合对激素受体阳性腋窝淋巴结阴性中分化早期乳腺癌的预后评估价值。
方法回顾性分析2012年5月至2017年5月于北京协和医院乳腺外科行手术治疗且行21基因检测的中分化早期乳腺癌患者的临床及病理资料, 根据21基因复发风险评分(recurrence score, RS)将患者分为RS低危组(RS < 18)、RS中危组(18 ≤ RS < 31)和RS高危组(RS ≥ 31), 同时按照PR表达及Ki-67指数设定PR与Ki-67指数组合, 将患者分为PK低危组(PR ≥ 10%且Ki-67 ≤ 20%)、PK高危组(PR < 10%且Ki-67>20%)及PK中危组(非高危或低危组), 分析并比较PK组合与RS评分的一致性。
结果共389例符合纳入及排除标准的患者入选本研究, 其中RS低危组247例(63.5%, 247/389), RS中危组115例(29.6%, 115/389), RS高危组27例(6.9%, 27/389); PK低危组248例(63.8%, 248/389), PK中危组125例(32.1%, 125/389), PK高危组16例(4.1%, 16/389)。推荐的PK组合对RS低危组和高危组的预测敏感度分别为75.3%和37.0%, 阳性预测值分别为75.0%和62.5%, 不一致性分别为0.4%和6.3%。中位随访40个月的结果显示, PK低、中、高危组的总事件发生率分别为3.6%、7.2%和12.5%, RS低、中、高危组的总事件发生率分别为3.2%、8.7%和7.4%, 两组差异无统计学意义(χ²=0.200, P=0.655)。
结论针对激素受体阳性腋窝淋巴结阴性中分化早期乳腺癌的PK组合具有与21基因RS评分相当的预后评估价值。

Abstract:
Objective To evaluate the prognostic value of the combination of progesterone receptor (PR) and Ki-67 index in grade 2 breast cancer with positive hormone receptor (HR) and negative axillary lymph node.
Methods The clinical and pathological data of patients with grade 2 breast cancer who underwent surgical treatment and 21 genes' recurrence score (RS) testing in the department of Breast Surgery, Peking Union Medical College Hospital from May 2012 to May 2017 were retrospectively analyzed. According to the 21 genes' RS, patients were divided into RS low-risk group (RS < 18), RS intermediate-risk group (18≤RS < 31), and RS high-risk group (RS≥31). At the same time, the combination of PR and Ki-67 index (PK) was set according to the expression of PR and Ki-67 index. The patients were divided into PK low-risk group (PR≥10% and Ki-67≤20%), PK high-risk group (PR < 10% and Ki-67>20%), and PK intermediate-risk group (non-high or low-risk group). The consistency of the PK combination and 21 genes' RS was analyzed and compared.
Results A total of 389 patients who met the inclusive and exclusive criteria were enrolled in this study, including 247 patients in RS low-risk group (63.5%, 247/389), 115 in RS intermediate risk group (29.6%, 115/389), 27 in RS high-risk group (6.9%, 27/389), 248 in PK low-risk group (63.8%, 248/389), 125 in PK intermediate risk group (32.1%, 125/389), 16 in PK high-risk group (4.1%, 16/389). The predictive sensitivity of the recommended PK combination for RS low risk and high-risk group was 75.3% and 37.0%, respectively, with the positive predictive values of 75.0% and 62.5%, and the inconsistency of 0.4% and 6.3%, respectively. After a median follow-up of 40 months, the total incidence of locoregional recurrence (LRR) and distant metastasis (DM) in PK low, intermediate, and high-risk group was 3.6%, 7.2%, and 12.5%, respectively. The total incidence of LRR and DM in RS low, intermediate, and high-risk groups was 3.2%, 8.7%, and 7.4%, respectively. There was no significant difference between PK combination and RS (P=0.655).
Conclusion The prognostic value of PK combination for HR-positive grade 2 early-stage breast cancer with negative axillary lymph nodes is comparable to that of the 21 genes' RS.

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