美國《臨床腫瘤雜誌》2017年7月31日在線先發

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

在「瑞典乳腺癌組91放射治療隨機化臨床試驗」中不同亞型乳腺癌保乳術后對放療的反應

目的

在一項大型、長期隨訪的隨機化臨床試驗中，我們評價了不同乳腺癌亞型保乳術后輔助放療（RT）的效果。

患者和方法

收集1003名患者的腫瘤組織，這些患者為淋巴結陰性、I-II期乳腺癌，於1991至1997年在「瑞典乳腺癌組91放療試驗」中隨機分組到保乳術±放射治療組，很少使用全身輔助治療（8%）。對958個腫瘤在組織晶元上用免疫組化和原位雜交技術確定乳腺癌亞型。

結果

放療降低了luminal A（19%對比9%，P=0.001）、luminalB（24%對比8%，P<0.001）和三陰乳腺癌（21%對比6%，P=0.08）同側乳腺癌複發（IBTR）的累計發生率，未降低人表皮生長因子受體2（HER2）陽性（luminal型和非luminal型）乳腺癌（15%對比19%，P=0.6）同側乳腺癌複發（IBTR）的累計發生率，但乳腺癌亞型之間放療效果上總差異的證據並不明顯（P=0.21）。對於三因乳腺癌，放療降低了死於乳腺癌的死亡率（風險比，0.35；P=0.06），但對於其它亞型則沒有。在所有亞型的乳腺癌中，放療沒有降低全因死亡率。放療使得事先假定的臨床低危組同側乳腺癌複發風險下降，放療降低了10年後同側乳腺癌複發作為首發事件的發生率（20%對比6%，P=0.008），但對死於乳腺癌的死亡率和全因死亡率沒有影響。

結論

在我們的研究中，儘管乳腺癌亞型並不能預測放療療效，但HER2陽性乳腺癌似乎對放療抵抗最大，而對乳腺癌死亡率影響最大者為三陰乳腺癌，在事先假定的低風險luminalA型乳腺癌中放療效果非常好。

《壹篇》南南和北北

Response to Radiotherapy After Breast-Conserving Surgery inDifferent Breast Cancer Subtypes in the Swedish Breast Cancer Group91 Radiotherapy Randomized Clinical Trial

Purpose

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

Patients and Methods

Tumor tissue was collected from 1,003 patients withnode-negative, stage I and II breast cancer who were randomlyassigned in the Swedish Breast Cancer Group 91 Radiotherapy trialbetween 1991 and 1997 to breast conservation surgery with orwithout RT. Systemic adjuvant treatment was sparsely used (8%).Subtyping was performed with immunohistochemistry and in situhybridization on tissue microarrays for 958 tumors.

Results

RT reduced the cumulative incidence of ipsilateral breast tumorrecurrence (IBTR) as a first event within 10 years for luminalA–like tumors (19% v 9%; P = .001), luminal B–like tumors (24% v8%; 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 wasweak (P = .21). RT reduced the rate of death from breast cancer(BCD) for triple-negative tumors (hazard ratio, 0.35; P = .06), butnot for other subtypes. Death from any cause was not improved by RTin any subtype. A hypothesized clinical low-risk group did not havea low risk of IBTR without RT, and RT reduced the rate of IBTR as afirst event after 10 years (20% v 6%; P = .008), but had no effecton BCD or death from any cause.

Conclusion

Subtype was not predictive of response to RT, although, in ourstudy, human epidermal growth factor receptor 2–positive tumorsseemed to be most radioresistant, whereas triple-negative tumorshad the largest effect on BCD. The effect of RT in the presumedlow-risk luminal A–like tumors was excellent.

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