英國曼徹斯特——在國際老年腫瘤學會(SIOG)2012年會上，來自英國諾丁漢大學的Kwok-Leung Cheung博士報告稱，患有可手術的原發性三陰性乳腺癌的老年患者雖然腫瘤體積大於年輕患者，但腫瘤的生物侵襲性可能較弱。

　　這份新的研究報告是對2011年在美國臨床腫瘤學會(ASCO)年會上所報告結果的補充(J. Clin. Oncol. 2011;29:abstr 1057)。當時，Cheung博士及其同事報告稱在2,000多名年齡≥70歲的老年女性中發現了127例三陰性乳腺癌患者，36年間(1973~2009年)她們均在同一家醫院接受了早期可手術原發性乳腺癌的治療，而且均有高質量的腫瘤樣本可供間接免疫組化法組織微陣列分析。

　　初始研究將這組患者的結果與之前分析的1986~1998年在同一家醫院接受治療的1,809例患者中的342例三陰性乳腺癌連續係列病例進行了對照。結果顯示，年輕患者和老年患者的5年乳腺癌特異性生存率(73% vs. 79%)、局部複發率(10% vs. 14%)、區域複發率(11% vs. 14%)和遠處複發率(30% vs. 27%)均相似。當時，Cheung博士及其團隊報告稱：“雖然老年患者沒有接受輔助化療，而將近一半的年輕患者都接受了化療，但老年係列病例的臨床結局與年輕患者基本類似。”

　　這項新的研究旨在確定年齡是否為決定患者臨床結局的一項重要因素，如果是，那麼是否可以找到一些生物標誌物。

　　這項研究表明，老年患者出現較大體積腫瘤(直徑≥2 cm)的幾率高於年輕患者，分別為66.7%和50.4%(P=0.002)。老年患者和年輕患者的腋窩淋巴結分期或淋巴結狀態無明顯差異。在年齡≥70歲的老年患者中，3級腫瘤占到了79.8%，而在年輕患者中占到了90.9%(P=0.007)。

　　生物標誌物分析顯示，將老年患者的腫瘤樣本與年輕患者相比，分別有48%和87.7%(P<0.001)呈Ki67陽性，分別有44.6%和55.6%(P=0.02)呈p53陽性。此外，在老年患者中，E-cadherin(P=0.002)和CK 7/8(P=0.005)的表達水平更低，但bcl2(P<0.001)、CK14(P=0.03)和CK18(P<0.001)的表達水平更高。

　　Cheung博士稱，這些數據可能有助於解釋為什麼老年女性雖然沒有接受侵襲性較強的輔助化療，但獲得的臨床結局卻仍然與年輕患者相似。 他指出：“輔助化療在這類患者治療中的確切作用還有待進一步的研究。”

　　法國裏昂Léon Bérard醫療中心的Catherine Terret博士評論道，上述研究結果與其憑直覺的猜測有所不同。他說：“臨床醫生對此會感到很驚訝，因為我感覺對於老年人而言，三陰性乳腺癌是一種侵襲性非常強的腫瘤。生物學分析的結果與我們臨床醫生的觀點完全不吻合，我真的感到很意外。”Terret博士沒有參與這項研究。

　　Cheung博士和Terret博士均聲明無相關利益衝突。

　　By: SARA FREEMAN, Ob.Gyn. News Digital Network

　　MANCHESTER, ENGLAND – Older women with primary, operable, triple-negative breast cancer may have less aggressive tumor biology despite being treated for larger tumors than their younger counterparts, new data suggest.

　　Tumor samples taken from women aged 70 years or older were found to be of lower grade with significantly lower expression of the tumor markers Ki67 and p53 than seen in younger women, investigators reported at the annual meeting of the International Society of Geriatric Oncology (SIOG).

　　These data may help explain why similar clinical outcomes were achieved despite aggressive adjuvant chemotherapy not being given to the more elderly women, said investigator Dr. Kwok-Leung Cheung, of the University of Nottingham, England. "The precise place of adjuvant chemotherapy in the treatment of these patients has yet to be defined," he said.

　　The new report adds to previous findings presented at the American Society of Clinical Oncology (ASCO) meeting in 2011, (J. Clin. Oncol. 2011;29:abstr 1057), Dr. Cheung noted.

　　At ASCO, Dr. Cheung and his coauthors reported that they had identified 127 older women with triple-negative breast cancer among more than 2,000 women, aged 70 years and older, who had been treated over a 36-year period (1973-2009) for early operable primary breast cancer at a single clinic and also who had good quality tumor samples available for tissue microarray analysis using indirect immunohistochemistry.

　　The initial study compared this group’s results with those of 342 women with triple-negative breast cancer in a previously characterized consecutive series of 1,809 patients treated at the same clinic from 1986 to 1998. The rates of 5-year breast cancer-specific survival (73% vs. 79%) and of local (10% vs. 14%), regional (11% vs. 14%), and distant (30% vs. 27%) recurrences were found to be similar in younger and older women, respectively.

　　"Despite not having received adjuvant chemotherapy, the older series had clinical outcome similar to the younger patients, almost half of which had chemotherapy," Dr. Cheung and team reported at the time.

　　The current investigation, therefore, looked to see whether age was an important factor in determining clinical outcome, and if so, whether there were any biologic markers.

　　Older women were found to be more likely to have larger tumors than do younger women, with 66.7% and 50.4% (P = .002), respectively, having tumors of 2 cm or greater in size. There was no difference between them in axillary stage or nodal status.

　　Fewer women aged 70 years and above had grade 3 tumors: 79.8%, vs. 90.9% of the younger women (P = .007).

　　Biomarker analysis showed 48% vs. 87.7% (P less than .001) of tumor samples were Ki67- and 44.6% vs. 55.6% (P = .02) p53-positive, comparing the older and younger women. There was also decreased expression of E-cadherin (P = .002) and CK 7/8 (P = .005), but increased expression of bcl2 (P less than .001), CK14 (P = .03), and CK18 (P less than .001) in the older women.

　　The findings are counterintuitive to what might be expected commented Dr. Catherine Terret of Centre Léon Bérard, in Lyon, France.

　　"I think this is surprising for the clinician because my feeling is triple-negative breast cancer in the elderly is a very aggressive tumor," Dr. Terret, who was not involved in the study, said. "I’m really surprised [the] biologic results don’t go in the same way as my clinical opinion."

　　Dr. Cheung and Dr. Terret had no relevant relationships to disclose.