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[乳腺病理] 首次涉及HER2亚型的SEER分析结果出炉

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发表于 2014-6-5 16:19:42 | 显示全部楼层 |阅读模式
  一项对涵盖了乳腺癌患者HER2状态的登记库数据的最新分析表明,在年龄较小、黑人和西班牙人群中侵袭性较强的乳腺癌亚型占的比例更大,并且不同亚型的临床表现存在明显差异。研究结果已发表在《美国国立癌症研究所杂志》(Journal of the National Cancer Institute)上。

  美国国立癌症研究所癌症控制与人口科学部的数学统计学家Nadia Howlader及其同事分析了来自17个基于人群的监测、流行病学与最终结果(SEER)登记库的数据,这些数据在全美人口中具有代表性,找到了36,810例于2010年被确诊为浸润性乳腺癌的女性患者,2010年是SEER纳入肿瘤HER2状态数据的第一年。除了有关肿瘤受体状态、分期、分级数据以外,数据库还纳入了有关患者年龄、种族/民族以及社会经济状况等信息。
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  Howlader女士及其同事发现,72.7%的乳腺癌患者为HR阳性(表达雌激素受体或孕激素受体)/HER2阴性(不表达人表皮生长因子2/neu);12.2%为三阴性(雌激素、孕激素和HER2受体均为阴性);10.3%为HR阳性/HER2阳性;4.6%为HR阴性/HER2阳性(J. Natl. Cancer Inst. 2014 April 28 [doi: 10.1093/jnci/dju055])。

  登记库中12%的浸润性乳腺癌病例没有相应的受体状态数据。

  研究者报告称,与HR阳性/HER2阴性患者相比,另外三种亚型的患者年龄偏小、属于少数民族或种族、居住在贫困程度较高的国家、疾病分期较晚、Bloom-Richardson分级较高的几率更大。

  在所有年龄组中,非西班牙裔黑人女性的三阴性乳腺癌发病率最高,60~64和65~69岁年龄段的发病率差异最大,即非西班牙裔黑人女性被诊断为这个亚型的几率远远高于其他种族/民族的女性。三阴性乳腺癌分级高(75% vs. 17%)、分期晚的几率都大大高于常见的HR阳性/HER2阴性亚型。

  与HR阳性/HER2阴性以及三阴性亚型相比,过度表达HER2的肿瘤是不太常见的亚型,这部分人群的种族/民族差异也较小。

  研究者报告称,与常见的HR阳性/HER2阴性亚型相比,另外三种亚型患者所占比例随年龄增加而下降;在年龄小于50岁的患者中这三种亚型占35%,但在年龄大于或等于75岁的患者中就只占20%了。

  Howlader女士及其同事称,虽然目前还不清楚导致上述种族和年龄差异的潜在原因,但这些最新数据“与影响临床转归的个性化治疗决策直接相关。”

  作者写道:“目前我们对于不同人群在乳腺癌亚型发生率和死亡率上差异的生物学基础了解甚少,仍需继续加强这方面的研究。” Howlader女士及其同事表示,SEER数据将继续支持这项研究。

  该研究由美国国立癌症研究所以及参与研究的SEER登记库共同资助。Howlader女士及其同事声明无相关经济利益冲突。

By: MARY ANN MOON, Oncology Practice Digital Network

FROM THE JOURNAL OF THE NATIONAL CANCER INSTITUTE

VITALS

Major finding: A total of 72.7% of invasive breast cancers diagnosed in the United States in 2010 were HR-positive (expressing either estrogen receptors or progesterone receptors) and HER2-negative (not expressing human epidermal growth factor 2-neu). Another 12.2% were found to be triple-negative (negative for estrogen, progesterone, and HER2 receptors), 10.3% were HR-positive and HER2-positive, and 4.6% were HR-negative but HER2-positive.

Data source: An analysis of SEER data involving a nationally representative sample of 36,810 cases of invasive breast cancer diagnosed in 2010.

Disclosures: This study was supported by the National Cancer Institute and the participating SEER registries. Ms. Howlader and her associates reported no financial conflicts of interest.

An analysis of recently available registry data including HER2 status for breast cancer patients confirms higher proportions of more aggressive breast cancer subtypes among younger women, black women, and Hispanic women, and notable differences in clinical presentation across subtypes, investigators reported in the Journal of the National Cancer Institute.

Although the reasons underlying these ethnic and age differences are not yet clear, the new data "are directly relevant to individualized treatment decisions that influence clinical outcomes," said Nadia Howlader of the National Cancer Institute, Bethesda, Md., and her colleagues.

They analyzed nationally representative data from 17 population-based Surveillance, Epidemiology, and End Results (SEER) registries, identifying 36,810 women diagnosed as having invasive breast cancer in 2010, the first year for which SEER data regarding tumor HER2 status were available. In addition to information on tumor receptor status, stage, and grade, the database includes information on patient age, race/ethnicity, and socioeconomic status.

Ms. Howlader, a mathematical statistician in the division of cancer control and population sciences, and her associates found that 72.7% of these breast cancers were HR-positive (expressing either estrogen receptors or progesterone receptors) and HER2-negative (not expressing human epidermal growth factor 2-neu); 12.2% were triple-negative (negative for estrogen, progesterone, and HER2 receptors); 10.3% were HR-positive and HER2-positive; and 4.6% were HR-negative but HER2-positive (J. Natl. Cancer Inst. 2014 April 28 [doi: 10.1093/jnci/dju055]).

The receptor status was unknown for 12% of the invasive breast cancer cases in the registries.

Compared with HR-positive and HER2-negative patients, those diagnosed with the other three subtypes were somewhat more likely to be younger, belong to minority racial or ethnic groups, live in counties with higher poverty levels, and have later-stage and higher Bloom-Richardson grade disease, the investigators reported.

Non-Hispanic black women had the highest incidence rates of triple-negative breast cancer across all age groups, with the difference in rates reaching its widest point at ages 60-64 and 65-69 years, when non-Hispanic black women were much more likely to be diagnosed with this subtype than were the other racial/ethnic groups. Triple-negative cancers were substantially more likely to be high-grade tumors (75% vs. 17%) and to present at an advanced stage than was the predominant HR-positive HER2-negative subtype.

The HER2-overexpressing tumors were less common subtypes with fewer observed variations by race/ethnicity, compared with both the HR-positive and HER2-negative, and triple-negative subtypes.

Compared with the predominant HR-positive and HER2-negative subtype, the proportion of women with the other three subtypes decreased with advancing age; these subtypes comprised 35% of case patients under age 50, but represented only 20% of case patients among those aged 75 years and older, the investigators reported.

"Understanding of the biological basis for differences in breast cancer subtype incidence and mortality across population groups is limited and warrants continued intensive study," the authors wrote. SEER data will continue to support this research, Ms. Howlader and her colleagues said.

This study was supported by the National Cancer Institute and the participating SEER registries. Ms. Howlader and her associates reported no financial conflicts of interest.

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