英国曼彻斯特——在国际老年肿瘤学会(SIOG)2012年会上，来自英国诺丁汉大学的Kwok-Leung Cheung博士报告称，患有可手术的原发性三阴性乳腺癌的老年患者虽然肿瘤体积大于年轻患者，但肿瘤的生物侵袭性可能较弱。

　　这份新的研究报告是对2011年在美国临床肿瘤学会(ASCO)年会上所报告结果的补充(J. Clin. Oncol. 2011;29:abstr 1057)。当时，Cheung博士及其同事报告称在2,000多名年龄≥70岁的老年女性中发现了127例三阴性乳腺癌患者，36年间(1973~2009年)她们均在同一家医院接受了早期可手术原发性乳腺癌的治疗，而且均有高质量的肿瘤样本可供间接免疫组化法组织微阵列分析。

　　初始研究将这组患者的结果与之前分析的1986~1998年在同一家医院接受治疗的1,809例患者中的342例三阴性乳腺癌连续系列病例进行了对照。结果显示，年轻患者和老年患者的5年乳腺癌特异性生存率(73% vs. 79%)、局部复发率(10% vs. 14%)、区域复发率(11% vs. 14%)和远处复发率(30% vs. 27%)均相似。当时，Cheung博士及其团队报告称：“虽然老年患者没有接受辅助化疗，而将近一半的年轻患者都接受了化疗，但老年系列病例的临床结局与年轻患者基本类似。”

　　这项新的研究旨在确定年龄是否为决定患者临床结局的一项重要因素，如果是，那么是否可以找到一些生物标志物。

　　这项研究表明，老年患者出现较大体积肿瘤(直径≥2 cm)的几率高于年轻患者，分别为66.7%和50.4%(P=0.002)。老年患者和年轻患者的腋窝淋巴结分期或淋巴结状态无明显差异。在年龄≥70岁的老年患者中，3级肿瘤占到了79.8%，而在年轻患者中占到了90.9%(P=0.007)。

　　生物标志物分析显示，将老年患者的肿瘤样本与年轻患者相比，分别有48%和87.7%(P<0.001)呈Ki67阳性，分别有44.6%和55.6%(P=0.02)呈p53阳性。此外，在老年患者中，E-cadherin(P=0.002)和CK 7/8(P=0.005)的表达水平更低，但bcl2(P<0.001)、CK14(P=0.03)和CK18(P<0.001)的表达水平更高。

　　Cheung博士称，这些数据可能有助于解释为什么老年女性虽然没有接受侵袭性较强的辅助化疗，但获得的临床结局却仍然与年轻患者相似。 他指出：“辅助化疗在这类患者治疗中的确切作用还有待进一步的研究。”

　　法国里昂Léon Bérard医疗中心的Catherine Terret博士评论道，上述研究结果与其凭直觉的猜测有所不同。他说：“临床医生对此会感到很惊讶，因为我感觉对于老年人而言，三阴性乳腺癌是一种侵袭性非常强的肿瘤。生物学分析的结果与我们临床医生的观点完全不吻合，我真的感到很意外。”Terret博士没有参与这项研究。

　　Cheung博士和Terret博士均声明无相关利益冲突。

　　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.