“妊娠相關(guān)乳腺癌”被定義為妊娠期間或分娩之后1年內(nèi)被診斷出的乳腺癌。

　　2018年8月7日，施普林格·自然旗下《乳腺癌研究與治療》在線發(fā)表韓國(guó)高麗大學(xué)安巖醫(yī)院、仁荷大學(xué)醫(yī)院、仁濟(jì)大學(xué)白醫(yī)院、高陽(yáng)國(guó)家癌癥中心、首爾大學(xué)盆唐醫(yī)院、慶北大學(xué)醫(yī)學(xué)中心、天主教大學(xué)圣文森特醫(yī)院、首爾大學(xué)首爾醫(yī)院的研究報(bào)告，根據(jù)臨床亞型分析了妊娠相關(guān)乳腺癌的臨床病理特征及其結(jié)局。

　　該研究從1996年1月1日～2015年12月31日韓國(guó)乳腺癌學(xué)會(huì)登記數(shù)據(jù)庫(kù)入組年齡20～49歲的乳腺癌女性患者共計(jì)8萬3792例。

　　結(jié)果發(fā)現(xiàn)乳腺癌生物學(xué)特征差異顯著：

• 妊娠無關(guān)乳腺癌患者：管腔A型最常見（50.6%），三陰型占16.4%，HER2型占9.1%

• 妊娠相關(guān)乳腺癌患者：三陰型最常見（40.4%），管腔A型占21.2%，HER2型占17.3%

　　患者總生存差異顯著：

• 妊娠無關(guān)乳腺癌患者：三陰型與其他亞型相比，死亡風(fēng)險(xiǎn)最高（風(fēng)險(xiǎn)比：2.3，95%置信區(qū)間：2.1～2.6）

• 妊娠相關(guān)乳腺癌患者：高Ki67管腔B型與其他亞型相比，死亡風(fēng)險(xiǎn)最高（風(fēng)險(xiǎn)比：7.0，95%置信區(qū)間：1.7～29.1）

　　根據(jù)不同亞型總生存多因素分析，妊娠相關(guān)乳腺癌與妊娠無關(guān)乳腺癌相比：

• HER2型乳腺癌的死亡風(fēng)險(xiǎn)較高（風(fēng)險(xiǎn)比：2.0，95%置信區(qū)間：1.1～3.7）

• 高Ki67管腔B型乳腺癌的死亡風(fēng)險(xiǎn)較高（風(fēng)險(xiǎn)比：4.4，95%置信區(qū)間：1.6～12.3）

　　因此，妊娠相關(guān)乳腺癌與妊娠無關(guān)乳腺癌相比，生物學(xué)特征顯著不同。尤其，高Ki67管腔B型和HER2型的妊娠相關(guān)乳腺癌結(jié)局不良。為了改善妊娠相關(guān)乳腺癌的結(jié)局，應(yīng)該根據(jù)不同亞型考慮不同治療。有必要開發(fā)妊娠期間可以使用的藥物。

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