Gonzalez-Angulo Ana M, McGuire Sean E, Buchholz Thomas A, Tucker Susan L, Kuerer Henry M, Rouzier Roman, Kau Shu-Wan, Huang Eugene H, Morandi Paolo, Ocana Alberto, Cristofanilli Massimo, Valero Vicente, Buzdar Aman U, Hortobagyi Gabriel N
Department of Breast Medical Oncology, Unit 424, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
J Clin Oncol. 2005 Oct 1;23(28):7098-104. doi: 10.1200/JCO.2005.11.124.
To identify clinicopathological factors predictive of distant metastasis in patients who had a pathologic complete response (pCR) after neoadjuvant chemotherapy (NC).
Retrospective review of 226 patients at our institution identified as having a pCR was performed. Clinical stage at diagnosis was I (2%), II (36%), IIIA (27%), IIIB (23%), and IIIC (12%). Eleven percent of all patients were inflammatory breast cancers (IBC). Ninety-five percent received anthracycline-based chemotherapy; 42% also received taxane-based therapy. The relationship of distant metastasis with clinicopathologic factors was evaluated, and Cox regression analysis was performed to identify independent predictors of development of distant metastasis.
Median follow-up was 63 months. There were 31 distant metastases. Ten-year distant metastasis-free rate was 82%. Multivariate Cox regression analysis using combined stage revealed that clinical stages IIIB, IIIC, and IBC (hazard ratio [HR], 4.24; 95% CI, 1.96 to 9.18; P < .0001), identification of < or = 10 lymph nodes (HR, 2.94; 95% CI, 1.40 to 6.15; P = .004), and premenopausal status (HR, 3.08; 95% CI, 1.25 to 7.59; P = .015) predicted for distant metastasis. Freedom from distant metastasis at 10 years was 97% for no factors, 88% for one factor, 77% for two factors, and 31% for three factors (P < .0001).
A small percentage of breast cancer patients with pCR experience recurrence. We identified factors that independently predicted for distant metastasis development. Our data suggest that premenopausal patients with advanced local disease and suboptimal axillary node evaluation may be candidates for clinical trials to determine whether more aggressive or investigational adjuvant therapy will be of benefit.
确定新辅助化疗（NC）后达到病理完全缓解（pCR）的患者发生远处转移的临床病理预测因素。
对本机构226例确诊为pCR的患者进行回顾性研究。诊断时的临床分期为I期（2%）、II期（36%）、IIIA期（27%）、IIIB期（23%）和IIIC期（12%）。所有患者中11%为炎性乳腺癌（IBC）。95%的患者接受了以蒽环类为基础的化疗；42%的患者还接受了以紫杉烷为基础的治疗。评估远处转移与临床病理因素的关系，并进行Cox回归分析以确定远处转移发生的独立预测因素。
中位随访时间为63个月。发生31例远处转移。10年无远处转移率为82%。使用联合分期进行多变量Cox回归分析显示，临床分期IIIB期、IIIC期和IBC（风险比[HR]，4.24；95%可信区间[CI]，1.96至9.18；P <.0001）、检出≤10个淋巴结（HR，2.94；95%CI，1.40至6.15；P =.004）和绝经前状态（HR，3.08；95%CI，1.25至7.59；P =.015）可预测远处转移。无上述因素的患者10年远处转移率为97%，有1个因素的为88%，有2个因素的为77%，有3个因素的为31%（P <.0001）。
一小部分达到pCR的乳腺癌患者会复发。我们确定了独立预测远处转移发生的因素。我们的数据表明，局部疾病晚期且腋窝淋巴结评估不理想的绝经前患者可能适合参加临床试验，以确定更积极或试验性的辅助治疗是否有益。
