pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

Estrogen receptor (ER), progesterone receptor (PR), and HER2 expression pre- and post- neoadjuvant chemotherapy in primary breast carcinoma: a single institutional experience

Background

The estrogen receptor (ER), progesterone receptor (PR), and HER2 profile of a primary breast carcinoma plays a significant role in patient management and treatment. Because of the increasing utilization of neoadjuvant chemotherapy or hormone therapy, surgically-resected carcinomas often show marked treatment effect. The aim of this study was to compare immunohistochemical (IHC) profiles (ER, PR, HER2, HER2 FISH) of primary breast carcinomas before and after neoadjuvant chemotherapy to assess the subsequent effects on hormone receptor status.

Design

Primary breast carcinomas from 38 female patients treated with neoadjuvant therapy after needle core biopsy or fine needle aspiration diagnosis were included. Histologic data was collected for each case, including site, type, grade, tumor size (cm), pre- and post- neoadjuvant treatment IHC panel (ER, PR, HER2), and fluorescence in-situ hybridization (FISH) for HER2.

Results

Of the 38 carcinomas studied, 45 % were positive for ER by IHC both pre- and post- neoadjuvant treatment (P=1.00). IHC studies for PR in these 38 patients showed 37% positivity for PR pre-neoadjuvant therapy and 21% positivity post-treatment (p=0.03). For 37 patients with HER2 IHC, 32% were positive pre-treatment, and 22% were positive post-treatment (P = 0.20). For 7 patients, HER2 FISH was positive in 71% pre-therapy and in 57% post-treatment (P=0.32).

Conclusions

Profiles for ER, HER2 IHC, and HER2 FISH were not significantly different in primary breast carcinomas before and after neoadjuvant chemotherapy. Further investigation is warranted to assess reproducibility of technique and investigate clinical implications of significant loss of PR status in treated patients.     

Changes in ER,PR and HER2 receptors status after neoadjuvant chemotherapy in breast cancer

Previous studies have reported conflicting results regarding the impact of neoadjuvant chemotherapy (NAC) on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status in breast cancer. Our aim was to investigate whether NAC induces some selective change in the breast biomarkers.     

乳腺癌新辅助化疗后临床评价与病理评价的差异分析

目的 探讨乳腺癌新辅助化疗后,临床疗效评价与病理评价之间存在差异的病理学基础.方法 收集中国医学科学院肿瘤医院2005年6月至2007年12月施行乳腺癌新辅助化疗的209例.新辅助化疗前均行核芯针穿刺活检.化疗结束后4周内实施乳腺癌根治术.新辅助化疗前后均对乳腺原发灶进行临床体检、乳腺X线检查和(或)超声检查.实施新辅助化疗后,依实体瘤的疗效评价标准(RECIST,1.1版)对乳腺癌原发灶进行临床疗效评价,依Miller和Payne(MP)分级系统进行病理评价.应用SPSS 15.0软件分析临床评价与病理评价的相关性.结果 (1)新辅助化疗后依临床体检结果进行临床评价:完全缓解33例,部分缓解124例,疾病稳定41例,疾病进展11例.(2)新辅助化疗前后均行乳腺X线检查87例,依乳腺X线检查进行临床评价:完全缓解8例,部分缓解42例,疾病稳定37例.(3)新辅助化疗后MP分级病理评价:1级14例,2级35例,3级106例,4级36例,5级18例.(4)临床体检相关的临床评价与病理评价存在统计学相关性(x2=33.668,P=0.001),乳腺X线检查相关的临床评价与病理评价存在统计学相关性(x2=22.404,P=0.004).(5)新辅助化疗病理评价与X线检查相关临床评价存在差异的病理学改变有:残存浸润癌以脉管瘤栓为主要表现形式;伴有大片黏液湖形成的黏液腺癌;导管内癌残存,伴明显沙砾样钙化及周围组织的沙砾样钙化;间质结节状纤维化等.结论 乳腺癌新辅助化疗的临床评价与病理评价存在统计学相关性.两者之间的差异有相应的病理学基础.伴有大片黏液湖形成的黏液腺癌、导管内癌的残存伴沙砾样钙化及间质结节状纤维化可能是临床评价低估治疗疗效的原因之一;而残存癌表现为脉管瘤栓可能是临床评价高估治疗疗效的原因之一.     

雄激素受体在乳腺癌中的表达及其与雌、孕激素受体和HER2的关系

目的 研究雄激素受体(AR)在乳腺浸润性导管癌中的表达及其与雌激素受体(ER)、孕激素受体(PR)和HER2状态的关系,探讨其作为乳腺癌治疗靶点的可行性.方法 采用免疫组织化学EnVision法检测AR、ER、PR、HER2在175例乳腺浸润性导管癌中的表达,依据结果分为腺腔A型、腺腔B型、HER2过表达型和三阴性型(ER-/PR-/HER2-)组.结果 175例中AR阳性88例(50.3%),AR表达与ER、PR、HER2均呈正相关(P＜0.01).腺腔A型53例(30.3%),腺腔B型33例(18.9%),HER2过表达型23例(13.1%),三阴性型66例(37.7%),AR阳性率分别为56.6%(30/53),75.8%(25/33)、47.8%(11/23)和33.3%(22/66),组间AR阳性率差异显著(x2=17.054,P=0.001).三阴性型组AR阳性者核分裂象较少(x2=5.140,P=0.023),腺腔A型组AR阳性者多为年轻患者(x2=4.567,P=0.033),差异有统计学意义.其他组内AR表达与否和临床病理学特征比较无统计学意义.结论 AR在乳腺癌中有较高的阳性率,可作为乳腺癌,特别是三阴性型乳腺癌的治疗靶点.     

Assessment of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status in the fine needle aspirates of metastatic breast carcinomas

The assessment of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2) status in the fine needle aspirates of metastatic breast carcinomas has prognostic and therapeutic implications. In this study, expression of ER, PR, and HER2 was assessed by immunohistochemical study in 70 cases of metastatic breast carcinomas and HER2 gene amplification was further evaluated by fluorescence in situ hybridization (FISH) in 38 (54%) cases. Positive expression of ER and PR was seen in 42 (60%) and 16 (23%) cases of metastatic breast carcinomas, respectively. HER2 immunoreactivity was scored as 0/1+ in 39 (56%), 2+ in 10 (14%), and 3+ in 21 (30%) cases. HER2 gene amplification was seen in 20% of HER2 2+ and 64% of HER2 3+ cases. ER, PR, and HER2 status in primary breast cancers were available to comparison in 31 cases (44%). The concordance rates between metastatic and primary breast carcinomas were 81% for ER, 65% for PR and 71% for HER2. Our study demonstrates that ER, PR, and HER2 status can be assessed in the fine needle aspirates of metastatic breast carcinomas and ER has a higher concordance rate between metastatic and primary breast carcinomas than PR and HER2. The addition of HER2 gene amplification FISH test helps in accurate assessment of HER2 status in metastatic breast carcinomas.     

Tumor-infiltrating lymphocytes are important pathologic predictors for neoadjuvant chemotherapy in patients with breast cancer

Neoadjuvant chemotherapy or preoperative systemic therapy is increasingly considered for patients with operable breast cancer. Patients with breast cancer were examined for pathologic factors predictive of response to neoadjuvant chemotherapy, using an anthracycline-based regimen. For clinical histomorphology and biomarkers, factors were compared among 16 pathologically complete responses and 52 nonpathologically complete responses, using univariate analysis and multivariate regression analysis of principal components, using preneoadjuvant chemotherapy needle biopsy samples as follows: degree of tumor-infiltrating lymphocytes, histologic grade, biology-based tumor type (hormone receptors and HER2 [human epidermal growth factor receptor type 2]), age, clinical TNM stage, and TNM staging. In univariate analysis, high tumor-infiltrating lymphocyte, high histologic grade, and hormone receptors(-)/HER2(+) were significantly associated with pathologically complete responses (93.7%, P < .0001; 81.3%, P = .0206; 43.7%, P = .014, respectively). In multivariate principal component regression analysis, high tumor-infiltrating lymphocytes were the best independent predictor for pathologically complete responses (odds ratio, 4.7; confidence interval, 2.2-10.06; P < .0001). Among tumor-infiltrating lymphocytes and biology-based tumor types, patients with high tumor-infiltrating lymphocytes had pathologically complete responses more than nonpathologically complete responses, especially in the hormone receptors(-)/HER2(+) group. Among high tumor-infiltrating lymphocyte cases, T lymphocytes showed more predominant tendency than B lymphocytes in the pathologically complete responses cases, compared with nonpathologically complete responses cases. These findings indicate that high tumor-infiltrating lymphocytes are important predictors of pathologically complete responses to neoadjuvant chemotherapy, especially in the hormone receptors(-)/HER2(+) group.     

乳腺癌新辅助化疗后临床评价与病理评价的差异分析

目的 探讨乳腺癌新辅助化疗后,临床疗效评价与病理评价之间存在差异的病理学基础.方法 收集中国医学科学院肿瘤医院2005年6月至2007年12月施行乳腺癌新辅助化疗的209例.新辅助化疗前均行核芯针穿刺活检.化疗结束后4周内实施乳腺癌根治术.新辅助化疗前后均对乳腺原发灶进行临床体检、乳腺X线检查和(或)超声检查.实施新辅助化疗后,依实体瘤的疗效评价标准(RECIST,1.1版)对乳腺癌原发灶进行临床疗效评价,依Miller和Payne(MP)分级系统进行病理评价.应用SPSS 15.0软件分析临床评价与病理评价的相关性.结果 (1)新辅助化疗后依临床体检结果进行临床评价:完全缓解33例,部分缓解124例,疾病稳定41例,疾病进展11例.(2)新辅助化疗前后均行乳腺X线检查87例,依乳腺X线检查进行临床评价:完全缓解8例,部分缓解42例,疾病稳定37例.(3)新辅助化疗后MP分级病理评价:1级14例,2级35例,3级106例,4级36例,5级18例.(4)临床体检相关的临床评价与病理评价存在统计学相关性(x2=33.668,P=0.001),乳腺X线检查相关的临床评价与病理评价存在统计学相关性(x2=22.404,P=0.004).(5)新辅助化疗病理评价与X线检查相关临床评价存在差异的病理学改变有:残存浸润癌以脉管瘤栓为主要表现形式;伴有大片黏液湖形成的黏液腺癌;导管内癌残存,伴明显沙砾样钙化及周围组织的沙砾样钙化;间质结节状纤维化等.结论 乳腺癌新辅助化疗的临床评价与病理评价存在统计学相关性.两者之间的差异有相应的病理学基础.伴有大片黏液湖形成的黏液腺癌、导管内癌的残存伴沙砾样钙化及间质结节状纤维化可能是临床评价低估治疗疗效的原因之一;而残存癌表现为脉管瘤栓可能是临床评价高估治疗疗效的原因之一.     

Prognostic value of Ki67 expression in HR-negative breast cancer before and after neoadjuvant chemotherapy

Background: Immunohistochemical (IHC) expression of Ki67 has been identified as a prognostic and predictive marker in hormone receptor (HR)-positive breast cancer, however, there is little evidence of the association of Ki67 with prognosis in HR-negative patients. We aimed to assess the benefit of Ki67 assessment in HR-negative breast cancers after neoadjuvant chemotherapy (NAC). Methods: In the present study, a total of 183 HR-negative breast cancer patients with Stage II to III that treated with anthracycline and/or taxane-based neoadjuvant chemotherapy between 2004 and 2011 were retrospectively analyzed. Endocrine therapy and trastuzumab was not administered to any patients in this study. Clinical and pathological features of the patients with breast cancer were retrieved from the hospital records. Predictive factors for NAC response and survival were analyzed. Results: Of the 183 patients, 122 (66.6%) were HR- HER2+, and 61 (33.3%) were triple-negative. The clinical response rates were similar across breast cancer subtype. Patients whose tumors contained high Ki67 expression effectively responded to NAC. Ki67 labeling index was a predictive marker for pathologic complete response (pCR). Ki67 expression showed a positive correlation with HER2 status, tumor size, lymph node status, lymphovascular invasion and tumor grade. Furthermore, high Ki67 expression in post-treatment tumors was strongly correlated with poor disease-free survival (DFS), but no correlation of Ki-67 expression with overall survival (OS) was observed. Conclusions: Our results suggest that Ki67 expression in HR-negative breast cancer may improve the assessment of pathological response after NAC, and Ki67 score in residual tumor was an independent prognosticator for DFS in the HR-negative breast cancer patients.     

Coordinated expression of ER, PR and HER2 define different prognostic subtypes among poorly differentiated breast carcinomas

Aims:  Histological grade is one of the most important prognostic factors in breast carcinomas, but poorly differentiated neoplasms still have quite heterogeneous biological behaviour, since they can be genetically classified as basal-like, HER2+ or even luminal. The aim was to analyse the frequency of oestrogen receptor (ER), progesterone receptor (PR) and HER2 expression profiles among breast carcinomas with <10% tubular formation, and their correlation with classic prognostic factors.
Methods and results:  One hundred and thirty-four samples of paraffin-embedded tumours were studied retrospectively. The tumours were classified in to four groups by their ER/PR/HER2 profile: (i) ER+ and/or PR+ but HER2−; (ii) ER+ and/or PR+ and HER2+; (iii) ER− and/or PR− but HER2+; and (iv) ER−, PR− and HER2− (triple-negative). The histological features of triple-negative and HER2+ carcinomas overlap. The only difference was the expression of basal cytokeratins (basal CK), which was more frequent among triple-negative carcinomas. Basal-CK expression defined a more aggressive group of tumours, according to the pathological features, regardless of the immunohistochemical profile.
Conclusions:  Group 1 and 2 tumours (ER+ and/or PR+ tumours with or without HER2 expression) were not statistically different, suggesting that poorly differentiated carcinomas with hormone receptors correspond to the luminal B type of tumour. Among poorly differentiated breast carcinomas, the classic profile associated with basal-CK identifies distinct subtypes equivalent to those seen by genetic classification.     

Evaluation of biomarker changes after administration of various neoadjuvant chemotherapies in breast cancer

To assess the changes in estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 expression in breast cancer patients after various neoadjuvant chemotherapies. Data from 138 locally advanced breast cancer patients with histological diagnoses were reviewed. Seventy patients (group 1) were given 4 cycles of 500 mg/m² cyclophosphamide and 50 mg/m² pirarubicin every 21 days. Sixty-eight patients (group 2) were given 4 cycles of 500 mg/m² cyclophosphamide and 75 mg/m² docetaxel every 21 days. The biomarker changes of the operated tumor tissues were compared with the initial core biopsies. ER, PR, HER2 and Ki-67 expression changed by 28.6%, 22.9%, 17.1% and 54.3%, respectively, after neoadjuvant chemotherapy in group 1 and 16.2%, 22.1%, 13.2% and 70.6%, respectively, after neoadjuvant chemotherapy in group 2. There were significant differences between the groups regarding ER and Ki-67 status changes, and these changes can be used to inform treatment strategies.