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美国《临床肿瘤杂志》：哪种亚型的乳腺癌对放疗效果好？

2017年08月02日

来源：桓兴医讯

美国《临床肿瘤杂志》2017年7月31日在线先发

http://ascopubs.org/doi/full/10.1200/JCO.2017.72.7263

在“瑞典乳腺癌组91放射治疗随机化临床试验”中不同亚型乳腺癌保乳术后对放疗的反应

目的

在一项大型、长期随访的随机化临床试验中，我们评价了不同乳腺癌亚型保乳术后辅助放疗（RT）的效果。

患者和方法

收集1003名患者的肿瘤组织，这些患者为淋巴结阴性、I-II期乳腺癌，于1991至1997年在“瑞典乳腺癌组91放疗试验”中随机分组到保乳术±放射治疗组，很少使用全身辅助治疗（8%）。对958个肿瘤在组织芯片上用免疫组化和原位杂交技术确定乳腺癌亚型。

结果

放疗降低了luminal A（19%对比9%，P=0.001）、luminal B（24%对比8%，P<0.001）和三阴乳腺癌（21%对比6%，P=0.08）同侧乳腺癌复发（IBTR）的累计发生率，未降低人表皮生长因子受体2（HER2）阳性（luminal型和非luminal型）乳腺癌（15%对比19%，P=0.6）同侧乳腺癌复发（IBTR）的累计发生率，但乳腺癌亚型之间放疗效果上总差异的证据并不明显（P=0.21）。对于三因乳腺癌，放疗降低了死于乳腺癌的死亡率（风险比，0.35；P=0.06），但对于其它亚型则没有。在所有亚型的乳腺癌中，放疗没有降低全因死亡率。放疗使得事先假定的临床低危组同侧乳腺癌复发风险下降，放疗降低了10年后同侧乳腺癌复发作为首发事件的发生率（20%对比6%，P=0.008），但对死于乳腺癌的死亡率和全因死亡率没有影响。

结论

在我们的研究中，尽管乳腺癌亚型并不能预测放疗疗效，但HER2阳性乳腺癌似乎对放疗抵抗最大，而对乳腺癌死亡率影响最大者为三阴乳腺癌，在事先假定的低风险luminal A型乳腺癌中放疗效果非常好。

Response to Radiotherapy After Breast-Conserving Surgery in Different Breast Cancer Subtypes in the Swedish Breast Cancer Group 91 Radiotherapy Randomized Clinical Trial

Purpose

To evaluate the effect of adjuvant radiotherapy (RT) after breast conservation surgery in different breast cancer subtypes in a large, randomized clinical trial with long-term follow-up.

Patients and Methods

Tumor tissue was collected from 1,003 patients with node-negative, stage I and II breast cancer who were randomly assigned in the Swedish Breast Cancer Group 91 Radiotherapy trial between 1991 and 1997 to breast conservation surgery with or without RT. Systemic adjuvant treatment was sparsely used (8%). Subtyping was performed with immunohistochemistry and in situ hybridization on tissue microarrays for 958 tumors.

Results

RT reduced the cumulative incidence of ipsilateral breast tumor recurrence (IBTR) as a first event within 10 years for luminal A–like tumors (19% v 9%; P = .001), luminal B–like tumors (24% v 8%; P < .001), and triple-negative tumors (21% v 6%; P = .08), but not for human epidermal growth factor receptor 2–positive (luminal and nonluminal) tumors (15% v 19%; P = .6); however, evidence of an overall difference in RT effect between subtypes was weak (P = .21). RT reduced the rate of death from breast cancer (BCD) for triple-negative tumors (hazard ratio, 0.35; P = .06), but not for other subtypes. Death from any cause was not improved by RT in any subtype. A hypothesized clinical low-risk group did not have a low risk of IBTR without RT, and RT reduced the rate of IBTR as a first event after 10 years (20% v 6%; P = .008), but had no effect on BCD or death from any cause.

Conclusion

Subtype was not predictive of response to RT, although, in our study, human epidermal growth factor receptor 2–positive tumors seemed to be most radioresistant, whereas triple-negative tumors had the largest effect on BCD. The effect of RT in the presumed low-risk luminal A–like tumors was excellent.

责任编辑：肿瘤资讯-Ruby