Different Prognostic Significance of Bcl-2 Based on Cancer Molecular Subtype
Journal of Breast Cancer
유방암은 다양한 성질을 가진 종양의 복합체이기 때문에, 각각의 환자의 치료방법을 결정하기 위하여는 예후인자와 예측인자를 찾 아 내는 것이 대단히 중요하다. 선택적 에스트로겐 조절자(selective estrogen receptor modifier), aromatase inhibitor, fulvestrant와 같은 호르몬 치료제와 더불어 human epidermal growth factor receptor 2 (HER2) 표적치료제가 도입되면서 이러한 경향은 더욱 강하여졌다. 현재 유방암의 분류와 치료에 있 어서 에스트로겐 수용체(estrogen receptor, ER) 및 프로게스테 론 수용체(progesterone receptor, PR)의 발현 유무, HER2의 발현 유무는 예후인자와 예측인자로서 대단히 중요한 의미를 가 진다.(1) 그러나, 호르몬수용체나 HER2가 발현되지 않는 삼중음 성 유방암의 경우에는 대체적으로 나쁜 예후를 보임에도 불구하 Purpose: B-cell
... 불구하 Purpose: B-cell lymphoma (bcl)-2 is an anti-apoptotic gene, and it is a poor prognostic factor in various malignant tumors. However, the prognostic significance of bcl-2 expression in breast cancer remains controversial. We investigated the prognostic significance of bcl-2 according to cancer molecular subtype. Methods: We analyzed 411 patients with primary invasive breast cancer who underwent surgery at our institution between 1999 and 2001. The subtypes were classified as luminal (estrogen receptor [ER]+ and/or progesterone receptor [PR]+, irrespective of human epidermal factor receptor 2 [HER2]), triple-negative (ER-, PR-, and HER2-), or HER2 (ER-,PR-, and HER2+). Results: A total of 236 (57.4%) cases were positive for bcl-2, and bcl-2 expression was significantly associated with earlier stage, lower grade, expression of hormone receptor positivity, and HER2 negativity. No difference in disease-free survival (DFS) was observed based on bcl-2 expression. However, the prognostic signifi-cance of bcl-2 varied with subtype; bcl-2 was not a prognosticator in patients with the luminal and HER2 subtypes. However, patients with bcl-2(+) tumors of the triple-negative subtype showed significantly worse DFS than those with bcl-2(-) tumors (p=0.048). In a multivariate analysis, bcl-2 expression remained a significant predictor of recurrence in patients with the triple-negative subtype (hazard ratio, 3.26; 95% confidence interval, 1.40-7.59; p=0.006). Conclusion: The prognostic significance of bcl-2 varied with molecular subtype; bcl-2 expression was a poor prognosticator in patients with the triple-negative subtype, but not in those with the luminal and HER2 subtypes.