Skrīninga atklātie vēži vs. simptomātiskie vēži : Klīniski-patoloģiskos in molekulāros parametrus salīdzinājums
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Date
2020
Authors
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Vispārīga informācija: Skrīnings mamogrāfijā tika ieviests Latvijā 2009. gadā ar mērķi diagnosticēt krūts vēža audzēju agrīnā, ārstējamā stadijā. Daudzi pētījumi atklāja, ka mamogrāfijas skrīninga programma var ievērojami samazināt mirstību no krūts vēža. Šis ievērojamais skrīninga atklāto vēža izdzīvošanas ieguvums prasa rūpīgu faktoru novērtējumu..
Mērķis: Salīdzināt skrīninga un simptomātiski atklāto krūts vēža klīniski patoloģiskos un molekulāros parametrus.
Metodes: Pētījumā tika iekļauti pacienti, kuriem 2019. gadā tika veikta ķirurģiskā ārstēšana Paula Stradiņa klīniskās universitātes slimnīcas Krūts slimību nodaļā. Retrospektīvi tika apkopoti klīniskie, patoloģiskie, molekulārie parametri un noteikšanas veids. Notingemas prognozes indekss tika aprēķināts visiem audzējiem un salīdzināts starp noteikšanas veidiem. Rezultāti tika analizēti, izmantojot programmatūru IBM SPSS Statistics 26.0.
Results: skrīninga atklātie vēži parasti bija mazāki, retāk limfmezglu pozitīvi un labāk diferencēti (p <0,0001). Sakarā ar šo skrīninga atklātie vēzi tika saistīti ar konservatīvāku krūšu operāciju un limfmezglu operāciju (attiecīgi p <0,0001 un 0,007). Izdzīvošanas prognoze, kas balstīta uz Notingemas prognozes indeksu, bija labāka skrīninga mamogrāfijas grupā (p <0,0001). Papildu, skrīninga atklātie vēži biežāk bija ER un PR pozitīvi (attiecīgi p = 0,037 un 0,008). Starp skrīninga un simptomātiskajām grupām nebija statistiski nozīmīgas atšķirības molekulārajos apakštipos (p = 0,265).
Secinājums: Ar skrīninga atklāts krūts vēzis uzrādīja labvēlīgākas klīniskās pazīmes un labāku izdzīvošanas prognozi. ER un PR statusi biežāk bija pozitīvi skrīninga atklātajos audzējos. Molekulāro apakštipu atšķirība starp skrīninga atklātajiem un simptomātiskajiem audzējiem nebija statistiski nozīmīga. Ir pamatoti veikt pētījumus ar lielāku paraugu un papildu molekulārajiem parametriem.
Background: Screening mammography was implemented in Latvia in 2009 with the aim of diagnosis breast cancer tumors at early, more curable stages. Numerous studies revealed that screening mammography program can achieve significant reduction in breast cancer mortality. This prominent survival benefit of screen-detected cancers calls for a thorough evaluation of factors behind it. Aim: To compare clinicopathological and molecular characteristics of screen-detected and symptomatic breast cancers. Methods: Patients who underwent surgical treatment in Pauls Stradiņš Clinical University Hospital, Breast Disease Unit in 2019 were included in the study. Clinical, pathological, molecular characteristics and mode of detection were collected retrospectively and studied. The Notthingham Prognostic Index was calculated for all tumors and compared between modes of detection. Results were analyzed using IBM SPSS statistics 26.0 software. Results: Screen-detected cancers tended to be smaller in size, less likely lymph node positive and more differentiated (p<0.0001). Due to this screen-detected cancers were associated with a more conservative breast surgery and lymph node surgery(p<0.0001 and 0.007, respectively). Survival prognosis based on the Nottingham Prognosic Index was more favorable in screening mammography group (p<0.0001). Additionally, screen-detected cancers were more likely to be ER and PR positive (p=0.037 and 0.008, respectively). There was no statistically significant difference in molecular subtypes between screening and symptomatic groups (p=0.265). Conclusion: Screen-detected breast cancer showed more favorable clinicopathological features and better survival prognosis. ER and PR statuses were more likely to be positive in screen-detected tumors. Molecular subtype difference between screen-detected and symptomatic tumors was statistically not significant. Investigation with bigger sample and additional molecular parameters is warranted.
Background: Screening mammography was implemented in Latvia in 2009 with the aim of diagnosis breast cancer tumors at early, more curable stages. Numerous studies revealed that screening mammography program can achieve significant reduction in breast cancer mortality. This prominent survival benefit of screen-detected cancers calls for a thorough evaluation of factors behind it. Aim: To compare clinicopathological and molecular characteristics of screen-detected and symptomatic breast cancers. Methods: Patients who underwent surgical treatment in Pauls Stradiņš Clinical University Hospital, Breast Disease Unit in 2019 were included in the study. Clinical, pathological, molecular characteristics and mode of detection were collected retrospectively and studied. The Notthingham Prognostic Index was calculated for all tumors and compared between modes of detection. Results were analyzed using IBM SPSS statistics 26.0 software. Results: Screen-detected cancers tended to be smaller in size, less likely lymph node positive and more differentiated (p<0.0001). Due to this screen-detected cancers were associated with a more conservative breast surgery and lymph node surgery(p<0.0001 and 0.007, respectively). Survival prognosis based on the Nottingham Prognosic Index was more favorable in screening mammography group (p<0.0001). Additionally, screen-detected cancers were more likely to be ER and PR positive (p=0.037 and 0.008, respectively). There was no statistically significant difference in molecular subtypes between screening and symptomatic groups (p=0.265). Conclusion: Screen-detected breast cancer showed more favorable clinicopathological features and better survival prognosis. ER and PR statuses were more likely to be positive in screen-detected tumors. Molecular subtype difference between screen-detected and symptomatic tumors was statistically not significant. Investigation with bigger sample and additional molecular parameters is warranted.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Krūts vēzis, Skrīnings, Atklāšanas metode, Molekulāri apakštipi, Audzēju parametri, Breast cancer, Screening, Mode of detection, Molecular subtypes, Tumor characteristics