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在三阴性乳腺癌中,纤维化灶、核分裂活性指数和 TIL(肿瘤浸润淋巴细胞)具有独立的预后价值:一项随访时间极长的观察性人群队列研究

英文原题:In triple-negative breast cancer, fibrotic focus, the mitotic activity index and tumour-infiltrating lymphocytes have independent prognostic value: an observational population-based cohort study with very long follow-up.

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In triple-negative breast cancer, fibrotic focus, the mitotic activity index and tumour-infiltrating lymphocytes have independent prognostic value: an observational population-based cohort study with very long follow-up.

PubMed 2025/08/18(内容时间) J Clin Pathol Q2 · IF 2.6(JCR 2025)

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研究概要

LN 状态、MAI5、FF 和 sTILs40 是 TNBC 患者的预后因素。在接受 ACT 的 TNBC 患者中,LN 阳性与 MAI5 联合可预测治疗反应。

研究思路结论见上方概要

三阴性乳腺癌(TNBC)在预后和治疗上具有异质性。有丝分裂活性指数(MAI)和纤维化灶(FF)已被确立为非TNBC的预测因子,但在TNBC中尚未确立。TNBC会发生晚期远处转移,但既往研究随访时间较短。高间质TIL(肿瘤浸润淋巴细胞)(sTILs)预后良好,但预后sTILs阈值尚未得到充分评估。我们在一个基于人群的观察性队列中评估了231例连续TNBC患者的预后/预测特征,随访时间长。

MAI、FF、sTILs及其他特征通过标准受试者工作特征曲线分析、百分位数推导的预后阈值、单变量和多变量生存方法进行分析。评估了TNBC指数和决策树对无远处转移生存的预测价值。

长期随访具有决定性意义:7%的患者发生了晚期远处转移。与TNBC的侵袭性特征一致,最强的预后MAI阈值为5(p=0.001),低于非TNBC表型。淋巴结(LN)状态(p=0.0003)、FF(p=0.002)、MAI5(p=0.009)和sTILs(阈值40%,p=0.003)是多变量分析中显著且独立的预后因素,但其他特征(年龄、肿瘤大小和分级)则不是。LN状态是最强的预后因素,其次是FF、MAI5和sTILs40。对接受辅助化疗(ACT)患者的亚组分析显示,只有FF和sTILs具有显著预后价值,而LN阳性和LN阳性联合MAI≥5可能是ACT结局的预测因素。

展开英文摘要原文

MAI, FF, sTILs and other characteristics were analysed with standard receiver operating characteristic curve analysis, percentile-derived prognostic thresholds, univariate and multivariate survival methods. A TNBC index and decision tree were assessed for distant metastasis-free survival.

Long follow-up was decisive: 7% of patients developed late distant metastases. In agreement with the aggressive nature of TNBC, the strongest prognostic MAI-threshold was 5 (p=0.001), lower than that for non-TNBC phenotypes. Lymph-node (LN) status (p=0.0003), FF (p=0.002), MAI5 (p=0.009) and sTILs (threshold 40%, p=0.003) were multivariable based significant and independent prognosticators, but no other characteristics (age, tumour size and grade). LN status was the strongest prognosticator, followed by FF, MAI5 and sTILs40. Subgroup analyses of patients undergoing adjuvant chemotherapy (ACT) showed that only FF and sTILs had significant prognostic value, while LN-positivity and the combination of LN-positivity and MAI≥5 could be a predictive factor for ACT outcome.

LN status, MAI5, FF and sTILs40 are prognostic factors in TNBC patients. In TNBC patients who have undergone ACT, the combination of LN-positivity and MAI5 is predictive for response to treatment.

论文信息

作者
Kiraz U、Rewcastle E、Pettersen KB、Abono DM、Raghe SH、Gudlaugsson EG、Baak JPA、Janssen EAM
单位
Department of Pathology, Stavanger University Hospital, Stavanger, Norway umaykiraz@gmail.com.Norway
文献类型
观察性研究
期刊
Journal of clinical pathology2025 Aug 18
原文标识
PubMed 39965885 · DOI 10.1136/jcp-2024-209855