妊娠相关乳腺癌结局的大数据分析

　　“妊娠相关乳腺癌”被定义为妊娠期间或分娩之后1年内被诊断出的乳腺癌。

　　2018年8月7日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表韩国高丽大学安岩医院、仁荷大学医院、仁济大学白医院、高阳国家癌症中心、首尔大学盆唐医院、庆北大学医学中心、天主教大学圣文森特医院、首尔大学首尔医院的研究报告，根据临床亚型分析了妊娠相关乳腺癌的临床病理特征及其结局。

　　该研究从1996年1月1日～2015年12月31日韩国乳腺癌学会登记数据库入组年龄20～49岁的乳腺癌女性患者共计8万3792例。

　　结果发现乳腺癌生物学特征差异显著：

• 妊娠无关乳腺癌患者：管腔A型最常见（50.6%），三阴型占16.4%，HER2型占9.1%

• 妊娠相关乳腺癌患者：三阴型最常见（40.4%），管腔A型占21.2%，HER2型占17.3%

　　患者总生存差异显著：

• 妊娠无关乳腺癌患者：三阴型与其他亚型相比，死亡风险最高（风险比：2.3，95%置信区间：2.1～2.6）

• 妊娠相关乳腺癌患者：高Ki67管腔B型与其他亚型相比，死亡风险最高（风险比：7.0，95%置信区间：1.7～29.1）

　　根据不同亚型总生存多因素分析，妊娠相关乳腺癌与妊娠无关乳腺癌相比：

• HER2型乳腺癌的死亡风险较高（风险比：2.0，95%置信区间：1.1～3.7）

• 高Ki67管腔B型乳腺癌的死亡风险较高（风险比：4.4，95%置信区间：1.6～12.3）

　　因此，妊娠相关乳腺癌与妊娠无关乳腺癌相比，生物学特征显著不同。尤其，高Ki67管腔B型和HER2型的妊娠相关乳腺癌结局不良。为了改善妊娠相关乳腺癌的结局，应该根据不同亚型考虑不同治疗。有必要开发妊娠期间可以使用的药物。

Breast Cancer Res Treat. 2018 Aug 7.

Clinical subtypes and prognosis of pregnancy-associated breast cancer: results from the Korean Breast Cancer Society Registry database.

Soo Youn Bae, Sei Joong Kim, JungSun Lee, Eun Sook Lee, Eun-Kyu Kim, Ho Young Park, Young Jin Suh, Hong Kyu Kim, Ji-Young You, Seung Pil Jung.

Korea University Anam Hospital, Korea University, Seoul, Korea; Inha University Hospital, Inha University School of Medicine, Incheon, Korea; Haeundae Paik Hospital, Inje University, Busan, Korea; National Cancer Center, Goyang-si, Korea; Seoul National University Bundang Hospital, Seoul National University, Gyeonggi, Korea; Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea; St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea; Korea University Hospital, Korea University, Seoul, Korea.

PURPOSE: We analyzed the clinicopathologic characteristics and prognosis of pregnancy-associated breast cancer (PABC) according to clinical subtypes to better understand the characteristics of PABC.

METHODS: A total of 83,792 female patients between the ages of 20 and 49 were enrolled in the Korean Breast Cancer Society Registry database from January 1, 1996 to December 31, 2015. 'PABC' is defined as breast cancer diagnosed during pregnancy or within 1 year after delivery. Other patients were defined as 'non-PABC' patients.

RESULTS: In non-PABC patients, luminal A subtype was the most common (50.2%). In PABC patients, TNBC was the most common (40.4%) subtype, while luminal A comprised 21.2% and HER2 subtype comprised 17.3%. There was a significant difference in overall survival (OS). In non-PABC patients, TNBC had the highest HR (HR 2.3, 95% CI 2.1-2.6). In PABC patients, the luminal B subtype (HR+ HER2- high Ki67) had the highest HR at 7.0 (95% CI 1.7-29.1). In multivariate analysis of OS by subtypes, PABC patients had significantly higher HR than non-PABC patients in the HER2 subtype (HR 2.0, 95% CI 1.1-3.7) and luminal B subtype (HR+ HER2- high Ki67) (HR 4.4, 95% CI 1.6-12.3).

CONCLUSION: PABC showed different biologic features than non-PABC. PABC had a particularly poor prognosis in the luminal B (HR+ HER2- high Ki67) and HER2 subtypes. To improve the prognosis of PABC, treatment should be considered according to subtype. Development of drugs that can be used during pregnancy is needed.

KEYWORDS: Pregnancy Breast cancer Subtype Prognosis

DOI: 10.1007/s10549-018-4908-6