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乳腺癌是一种常见的恶性肿瘤, 近年来发病率明显增高, 已经跃居女性肿瘤的首位, 严重危害女性的健康[1], 对于乳腺癌的预后判断目前仍无较好的指标。肿瘤间质比(tumor-stroma ratio, TSR)的概念最早是由MESKER等提出的, 指的是肿瘤组织内肿瘤间质与实质的比值, 其最先应用于大肠癌的预后评估[2], 在乳腺癌方面的研究较少。本文旨在探讨TSR在乳腺癌预后的评估作用及其与临床病理关系, 现作报道。
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120例乳腺癌病人中高TSR 50例, 占41.67%, 低TSR 70例, 占58.33%。
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相关性分析显示, 乳腺癌TSR与组织学分级、肿瘤淋巴结阳性呈正相关(P < 0.01), 与其他病理因素相关性无统计学意义(P>0.05)(见表 1)。
病理因素 r P 淋巴结阳性 0.302 < 0.01 肿瘤大小 -0.131 >0.05 雌激素受体 -0.138 >0.05 孕激素受体 -0.124 >0.05 Her-2 0.162 >0.05 组织学分级 0.295 < 0.01 表 1 乳腺癌TSR与临床病理因素相关性分析
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logistic单因素分析发现, 乳腺癌预后与TSR、组织学分级、肿瘤淋巴结情况相关性有统计学意义(P < 0.05~P < 0.01), 与其他病理因素相关性无统计学意义(P>0.05)(见表 2)。
病理因素 B SE Waldχ2 P 95% CI TSR 1.770 0.550 10.37 < 0.01 1.999~17.236 组织学分级 1.724 0.680 6.43 < 0.01 1.478~21.270 淋巴结阳性 1.555 0.709 0.71 < 0.05 0.053~0.848 Her-2 -38.167 8901.913 0.00 >0.05 - 肿瘤大小 -19.386 6234.929 0.00 >0.05 - 表 2 乳腺癌预后单因素分析
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120例乳腺癌病人随访至2018年7月或病人死亡时间, 其中随访最短时间为7个月, 高TSR病人死亡5例, 低TSR病人死亡10例, 通过COX多因素分析显示病人总生存期与TSR有密切相关性(P < 0.01), 与其他病理因素相关性无统计学意义(P>0.05)(见表 3)。
临床病理因素 HR P TSR 10.371 < 0.01 组织学分级 0.282 >0.05 淋巴结阳性 1.132 >0.05 肿瘤大小 0.083 >0.05 雌激素受体 0.079 >0.05 孕激素受体 0.041 >0.05 Her-2 0.749 >0.05 表 3 乳腺癌预后COX多因素分析
肿瘤间质比在乳腺癌预后评估中的价值研究
Value of tumor-stroma ratio in the prediction of the prognosis of breast cancer
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摘要:
目的了解肿瘤间质比(TSR)在乳腺癌预后的评估作用及其与临床病理关系。 方法收集120例乳腺癌病人肿瘤组织标本经HE染色后在显微镜下寻找肿瘤浸润明显区域3个视野寻找肿瘤细胞,取最高值。并随访病人的预后情况,分析TSR与乳腺癌临床病理关系及预后的关系。 结果TSR与乳腺癌的淋巴结转移(r=0.302)、组织学分级(r=0.295)具有相关性(P < 0.01)。预后的单因素和多因素分析均显示TSR是乳腺癌的独立预后因素(P < 0.01)。 结论TSR是乳腺癌的独立预后因素,且其检测具有重复性高、操作简单等优势,值得临床推广。 Abstract:ObjectiveTo explore the value of tumor-stroma ratio(TSR) in the assessment of the prognosis of breast cancer, and its correlation with clinicopathology. MethodsOne hundred and twenty tumor tissue samples of breast cancer patients were stained using HE, the tumor cells in three visual fields with obvious tumor infiltration were calculated to obtain the highest value under the microscope.All cases were followed up, and the relationship between TSR, and clinicopathology and prognosis of breast cancer were analyzed. ResultsThe TSR was correlated with the lymph node metastasis and histological grade(P < 0.01).The single and multivariate analysis of prognosis showed that the TSR was an independent prognostic factor of breast cancer(P < 0.01). ConclusionsThe TSR is an independent prognostic factor of breast cancer, which has high repeatability and simple operation, and is worthy of clinical promotion. -
Key words:
- breast neoplasms /
- tumor-stroma ratio /
- prognosis
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表 1 乳腺癌TSR与临床病理因素相关性分析
病理因素 r P 淋巴结阳性 0.302 < 0.01 肿瘤大小 -0.131 >0.05 雌激素受体 -0.138 >0.05 孕激素受体 -0.124 >0.05 Her-2 0.162 >0.05 组织学分级 0.295 < 0.01 表 2 乳腺癌预后单因素分析
病理因素 B SE Waldχ2 P 95% CI TSR 1.770 0.550 10.37 < 0.01 1.999~17.236 组织学分级 1.724 0.680 6.43 < 0.01 1.478~21.270 淋巴结阳性 1.555 0.709 0.71 < 0.05 0.053~0.848 Her-2 -38.167 8901.913 0.00 >0.05 - 肿瘤大小 -19.386 6234.929 0.00 >0.05 - 表 3 乳腺癌预后COX多因素分析
临床病理因素 HR P TSR 10.371 < 0.01 组织学分级 0.282 >0.05 淋巴结阳性 1.132 >0.05 肿瘤大小 0.083 >0.05 雌激素受体 0.079 >0.05 孕激素受体 0.041 >0.05 Her-2 0.749 >0.05 -
[1] 李新, 刘薇, 牛冰等.CAIX在乳腺癌中的表达及其临床意义[J].中国现代医学杂志, 2018, 28(17):42. doi: 10.3969/j.issn.1005-8982.2018.17.008 [2] SCHEER R, BAIDOSHVILI A, ZOIDZE S, et al.Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma:a retrospective cohort study[J].World J Gastrointes Toncol, 2017, 9(12):466. doi: 10.4251/wjgo.v9.i12.466 [3] SALVATORE V, TETI G, FOCAROLI S, et al.The tumor microenvironment promotes cancer progression and cell migration[J].Oncotarget, 2017, 8(6):9608. [4] GASCARD P, TLSTY TD.Carcinoma-associated fibroblasts:orchestrating the composition of malignancy[J].Genes Dev, 2016, 30(9):1002. doi: 10.1101/gad.279737.116 [5] 陈翱翔, 余岳, 孟然等.肿瘤浸润淋巴细胞比例对乳腺癌新辅助化疗疗效的预测作用[J].中国肿瘤临床, 2017, 44(23):1184. doi: 10.3969/j.issn.1000-8179.2017.23.994 [6] HUIJBERS A, TOLLENAAR RA, VPELT GW, et al.The proportion of tumor-st roma as a strong prognosticator for stageⅡand Ⅲ colon cancer patients:Validation in the VICTOR trial[J].Ann Oncol, 2013, 24(1):179. doi: 10.1093/annonc/mds246 [7] WANG K, MA W, WANG J, et al.Tumor-stroma ratio is an independent predictor for survival in esophageal squamous cell carcinoma[J].J Thorac Oncol, 2012, 7(9):1457. doi: 10.1097/JTO.0b013e318260dfe8 [8] PONGSURAREEYAKUL T, KHUNAMORNPONG S, SETTAKORN J, et al.Prognosticevaluation of tumor-stroma ratio in patients with early stage cervical adenocarcinoma treated by surgery[J].Asia Pac J Cancer Prev, 2015, 16(10):4363. doi: 10.7314/APJCP.2015.16.10.4363 [9] ZHANG T, XU J, SHEN H, et al.Tumor-stroma ratio is an independent predictor for survival in NSCLC[J].Int J Clin Exp Pathol, 2015, 8(9):11348. [10] DEKKER TJ, VANDE VELDE CJ, VANPELT GW, et al.Prognostic significance of the tumor-stroma ratio:Validation study in node-negative premenopausal breast cancer patients from the EORTC Perioperative chemotherapy(POP)trial(10854)[J].Breast Cancer Res Trea, 2013, 139(2):371. doi: 10.1007/s10549-013-2571-5 [11] ROCKE T, SOBRAL-LEITE M, DEKKER JA, et al.The prognostic value of the tumor stroma ratio in primary operable invasive cancer of the breast:a validation study[J].Breast Cancer Res Treat, 2017, 166(2):435. doi: 10.1007/s10549-017-4445-8 [12] 张溪, 胡柏来, 吕震等.肿瘤间质比及肿瘤浸润性淋巴细胞对晚期结直肠癌的预后价值[J].中国肿瘤临床, 2015, 42(4):241. doi: 10.3969/j.issn.1000-8179.20142129 [13] MILLER P, KIDWELL KM, THOMAS D, et al.Elevated S100A8 Protein expression in breast cancer cell and breast tumor stroma ratio is prognostic of poor disease outcome[J].Breast cancer Res Treat, 2017, 166(1):85. doi: 10.1007/s10549-017-4366-6