Jeruss Jacqueline S, Mittendorf Elizabeth A, Tucker Susan L, Gonzalez-Angulo Ana M, Buchholz Thomas A, Sahin Aysegul A, Cormier Janice N, Buzdar Aman U, Hortobagyi Gabriel N, Hunt Kelly K
Department of Surgery, Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, USA.
Cancer Res. 2008 Aug 15;68(16):6477-81. doi: 10.1158/0008-5472.CAN-07-6520.
The use of neoadjuvant chemotherapy has become more prevalent in the treatment of breast cancer patients. The finding of a pathologic complete response to neoadjuvant chemotherapy (no evidence of residual invasive cancer in the breast and lymph nodes at the time of surgical resection) has been shown to correlate with improved survival. The current version of the American Joint Committee on Cancer (AJCC) staging for breast cancer has a pretreatment clinical stage designation that is determined by clinical and radiographic examination of the patient and a postoperative pathologic stage classification based on the findings in the breast and regional lymph nodes removed at surgery. Pathologic staging has not been validated for patients receiving neoadjuvant chemotherapy; thus, prognosis is determined for these patients based on the pretreatment clinical stage. We hypothesized that clinical and pathologic staging variables could be combined with biological tumor markers to provide a novel means of determining prognosis for patients treated with neoadjuvant chemotherapy. Two scoring systems, based on summing binary indicators for clinical and pathologic substages, negative estrogen receptor status, and grade 3 tumor pathology, were devised to predict 5-year patient outcomes. These scoring systems facilitated separation of the study population into more refined subgroups by outcome than the current AJCC staging system for breast cancer, and provide a novel means for evaluating prognosis after neoadjuvant therapy.
新辅助化疗在乳腺癌患者治疗中的应用越来越普遍。新辅助化疗后病理完全缓解（手术切除时乳房和淋巴结无残余浸润性癌证据）的发现已被证明与生存率提高相关。美国癌症联合委员会（AJCC）当前版本的乳腺癌分期有一个术前临床分期指定，它由对患者的临床和影像学检查确定，以及一个基于手术切除的乳房和区域淋巴结中的发现的术后病理分期分类。病理分期尚未在接受新辅助化疗的患者中得到验证；因此，这些患者的预后是根据术前临床分期确定的。我们假设临床和病理分期变量可以与生物肿瘤标志物相结合，以提供一种确定接受新辅助化疗患者预后的新方法。设计了两个评分系统，基于对临床和病理亚阶段、雌激素受体阴性状态以及3级肿瘤病理的二元指标求和，以预测患者5年的预后。与当前AJCC乳腺癌分期系统相比，这些评分系统有助于根据预后将研究人群分为更精细的亚组，并为评估新辅助治疗后的预后提供了一种新方法。
