肿瘤内部异质性高的ER阳性的乳腺癌患者比异质性低的死亡风险高

发表于 J Natl Cancer Inst. 2018 Jul 的文章研究了 STO-3 临床试验的 1780 名绝经后，没有淋巴结转移的ER阳性的乳腺癌患者，使用 Rao's quadratic entropy 来量化其中的808个还存有FFPE样品的病人的ER受体多样性情况。发现这些ER阳性的乳腺癌患者的ER异质性在 luminal A or luminal B subtype分布没有明显区别。但是生存分析，发现ER的异质性分组却明显跟生存统计学相关。

关于STO-3

设计如下：

结果是：

A statistically significant difference in long-term survival by high vs low intratumor heterogeneity of ER was seen for all ER-positive patients (P < .001) and for patients with luminal A subtype tumors (P = .01).

病理切片的ER受体情况判断

标准非常严格：

Ten pathologists (RB, JB, PC, YC, BD, FH, GK, FL, YZ, and AB) at the University of California with expertise in breast diagnostics, as a part of the ATHENA Breast Health network, scored (on whole-tumor sections with microscopes) the percentage of positive breast cancer cells for each ER intensity level (0, +1, +2, or + 3) compared with established standards, after completing an online training module developed to standardize the distinctions between intensity levels

其中652个样品进行了Agilent基因表达芯片检测，使用PAM50进行分类： (luminal A, luminal B, HER2-enriched, basal-like, normal-like)