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目的:分析激素受体阳性的早期乳腺癌病人21基因复发风险评分(recurrence score,RS)与临床病理特征的相关性,并比较不同管腔(luminal)型乳腺癌划分标准与RS的关系。方法:收集2014年1月至2015年6月瑞金医院乳腺疾病诊治中心手术治疗后接受21基因检测的早期女性乳腺癌病人,回顾分析RS与临床病理特征的相关性。结果:共入组379例病人,其中低危RS 86例(22.7%),中危RS 229例(60.4%),高危RS 64例(16.9%)。单因素分析结果显示,在不同雌激素受体、孕激素受体(progesterone receptor,PgR)、Ki67表达及组织学分级的乳腺癌病人中,RS存在统计学差异(P值分别为0.011,<0.001,<0.001,<0.001)。多因素分析表明,PgR、Ki67表达及组织学分级是RS评分的独立影响因素(P值分别为0.001,0.006,0.045)。分别以Ki67≥14%和≥20%作为luminal A型和luminal B型乳腺癌的划分标准,进行RS的分层分析显示,两者的RS较为一致。结论 :在激素受体阳性早期乳腺癌病人中,Pg R、Ki67及组织学分级是影响RS的独立影响因素。根据Ki67不同表达水平进行luminal A型和luminal B型乳腺癌的划分,不影响RS。
OBJECTIVE: To analyze the correlation between 21 recurrence score (RS) and clinicopathological features in hormone receptor positive early breast cancer patients and to compare the relationship between different luminal breast cancer classification criteria and RS. Methods: A retrospective analysis of the correlation between RS and clinicopathological features was performed in early breast cancer patients who underwent 21 gene tests after surgical treatment of the Breast Disease Diagnosis and Treatment Center of Ruijin Hospital from January 2014 to June 2015. Results: A total of 379 patients were enrolled. Among them, 86 (22.7%) were low risk RS, 229 (60.4%) were moderate risk and 64 (16.9%) were high risk RS. Univariate analysis showed that there were significant differences in RS between breast cancer patients with different estrogen receptor, progesterone receptor (PgR), Ki67 expression and histological grading (P = 0.011, <0.001 , <0.001, <0.001). Multivariate analysis showed that PgR, Ki67 expression and histological grade were the independent influential factors of RS score (P = 0.001, 0.006, 0.045, respectively). Respectively, with Ki67 ≥ 14% and ≥ 20% as luminal A type and luminal B type of breast cancer standard, RS stratification analysis showed that the two RS is more consistent. Conclusion: Pg R, Ki67 and histological grade are the independent influential factors of RS in hormone receptor positive early breast cancer patients. According to the different expression levels of Ki67 luminal A type and luminal B type of breast cancer division, does not affect the RS.