Background. Implementing mammogram screening means that clinicians are seeing many breast cancers that will never develop metastases. The purpose of this study was to identify subgroups of breast cancer patients who did not present events related to long-term breast cancer mortality, taking into account diagnosis at breast screening, absence of palpability and axillary involvement, and genomic analysis with PAM50. Patients and Methods. To identify them, a retrospective observational study was carried out selecting patients without any palpable tumor and without axillary involvement, and a genomic analysis was performed with PAM50. Results. The probability of distant metastasis-free interval (DMFI) of 337 patients was 0.92 (95% CI, 0.90–0.93) at 20 years and 0.96 (95% CI, 0.92–1.00) in 95 patients (28%) with available PAM50 tests. In 22 (23.15%) luminal A tumors and in 9 (9.47%) luminal B tumors smaller than 1 cm, and in HER2 and basal type tumors, there were no metastatic events (20-year DMFI of 1.00). Conclusion. Patients with nonpalpable breast cancer found at screening with negative nodes are at very low risk. It is possible to identify subgroups without metastatic events by determining the intrinsic subtype and tumor size less than 1 cm. Therefore, de-escalation of treatment should be considered.
背景：随着乳腺X线筛查的普及，临床中发现的许多乳腺癌实际上并不会发生转移。本研究旨在结合乳腺筛查诊断、无触及性肿块、无腋窝淋巴结受累以及PAM50基因组分析，识别出与长期乳腺癌死亡率无关事件的患者亚组。患者与方法：通过回顾性观察研究，筛选无触及性肿瘤且无腋窝淋巴结受累的患者，并采用PAM50进行基因组分析。结果：337例患者的20年无远处转移间期（DMFI）概率为0.92（95% CI，0.90–0.93）；其中95例（28%）获得PAM50检测结果的患者为0.96（95% CI，0.92–1.00）。在22例（23.15%）管腔A型肿瘤和9例（9.47%）管腔B型肿瘤（直径小于1 cm）以及HER2型和基底型肿瘤中，均未观察到转移事件（20年DMFI为1.00）。结论：筛查发现的无触及性乳腺癌且淋巴结阴性患者的转移风险极低。通过确定肿瘤内在亚型及直径小于1 cm，可识别无转移事件的亚组。因此，应考虑对这些患者实施降阶梯治疗。
Clinicopathological and Genomic Identification of Breast Cancers with No Impact on Mortality
肿瘤(癌症)患者之家