机译
乳腺癌的肿瘤内形态异质性作为转移潜能和肿瘤化学敏感性的指标
摘要:Breast cancer (BC) demonstrates considerable intratumoral morphological heterogeneity. The aim of this work was to evaluate the relationship among different morphological structures, the rate of metastasis, and efficacy of neoadjuvant chemotherapy (NAC) in NAC-treated (n = 427) and NAC-naïve (n = 249) BC patients. We also studied the involvement of an epithelial-mesenchymal transition (EMT) in the development of the intratumoral morphological heterogeneity of BC. We found a significant association between the intratumoral morphological heterogeneity and the rate of BC metastasis and response to NAC, which, in most cases, correlated with the presence of alveolar and trabecular structures. In particular, the rate of lymph node metastasis in tumors containing alveolar and trabecular structures was higher compared to that in tumors lacking such structures. NAC-treated patients with alveolar and trabecular structures had a high distant metastasis rate and a low metastasis-free survival rate. Furthermore, alveolar and trabecular structures were found to be associated with a lack of response to NAC. Interestingly, the association between alveolar structures and a highdistant metastasis rate was found only in NAC-unresponsive patients, whereasthe association between trabecular structures and an increased distantmetastasis was revealed in responders. Alveolar structures were associated withchemoresistance only in patients with lymph node metastases, whereas trabecularstructures were associated with chemoresistance only in patients without lymphnode metastases. In general, increased intratumoral morphological diversitycorrelated with considerable chemoresistance and a high metastasis rate of BC.We found variable expressions of epithelial (EPCAM andCDH1) and mesenchymal (ITGA5,ITGB5, CDH2, CDH11,TGFb2, ZEB1, MMP2,DCN, MST1R) markers and, thus, different EMTmanifestations in different morphological structures. Therefore, intratumoralmorphological heterogeneity of BC may serve as an indicator of the metastaticpotential and tumor chemosensitivity.