Kulka Janina, Tokés Anna-Mária, Tóth Adrienn Ildikó, Szász Attila Marcell, Farkas Andrea, Borka Katalin, Járay Balázs, Székely Eszter, Istók Roland, Lotz Gábor, Madaras Lilla, Korompay Anna, Harsányi László, László Zsolt, Rusz Zoltán, Molnár Béla Akos, Molnár István Arthur, Kenessey István, Szentmártoni Gyöngyvér, Székely Borbála, Dank Magdolna
Semmelweis Egyetem II. sz. Patológiai Intézet 1091 Budapest Ulloi út 93.
Magy Onkol. 2009 Dec;53(4):335-43. doi: 10.1556/MOnkol.53.2009.4.2.
The purpose of the study was to identify breast cancer subtypes by immunohistochemistry likely to respond to neoadjuvant chemotherapy and to analyze the used chemotherapy regimen and the range of response rates. Analysis of a collected database was performed. Ninety-two patients were identified in our files who received neoadjuvant chemotherapy between 1998 and 2009. We used immunohistochemical profiles (ER, PgR, HER2, Ki-67 and p53) of NCB, FNAB and surgical breast specimens to subclassify the tumors. Pathological response rates were assessed following surgical removal of tumors by using the Chevallier classification. DFS and OS was measured in 88 cases from the date of definitive surgery to the date of last follow-up or death. Pathological complete or near-complete remission (pCR = Chevallier I and II) was observed in 13 of 92 cases (14.1%). According to the preoperative characteristics of the 13 tumors achieving pCR, 9 of the cases were triple negative, one of 13 was ER-/HER2+ and three of 13 ER+/HER2+. Twenty-four of 92 patients received taxane based neoadjuvant chemotherapy, 30 of 92 anthracycline based neoadjuvant chemotherapy, 33 of 92 taxane + anthracycline regimen and 2 of 92 CMF regimen. In the taxane treated group of patients the pCR rate was 29.1%, in the anthracycline group 6.6% and in the taxane + anthracycline treated group 12.1%. Concerning DFS, significant difference was observed between the Chevallier III and IV groups (p=0.006), and less events were observed in the pCR group (not significant). pCR was associated with significantly better OS (p=0.050). It seems that even limited, routinely used immunohistochemical profiling of tumors is able to predict the likelihood of pCR to neoadjuvant chemotherapy. Patients with triple negative and HER2-positive cancers are likely to achieve pCR after neoadjuvant chemotherapy.
本研究的目的是通过免疫组织化学确定可能对新辅助化疗有反应的乳腺癌亚型，并分析所使用的化疗方案及反应率范围。对收集的数据库进行了分析。在我们的档案中识别出92例在1998年至2009年间接受新辅助化疗的患者。我们使用粗针穿刺活检（NCB）、细针穿刺抽吸活检（FNAB）和手术切除的乳腺标本的免疫组织化学图谱（雌激素受体（ER）、孕激素受体（PgR）、人表皮生长因子受体2（HER2）、Ki-67和p53）对肿瘤进行亚分类。在手术切除肿瘤后，采用谢瓦利埃分类法评估病理反应率。对88例患者从确定性手术日期至最后一次随访或死亡日期测量无病生存期（DFS）和总生存期（OS）。92例患者中有13例（14.1%）观察到病理完全缓解或接近完全缓解（pCR = 谢瓦利埃I和II级）。根据达到pCR的13例肿瘤的术前特征，其中9例为三阴性，13例中的1例为ER-/HER2+，13例中的3例为ER+/HER2+。92例患者中有24例接受了紫杉烷类新辅助化疗，92例中有30例接受了蒽环类新辅助化疗，92例中有33例接受了紫杉烷 + 蒽环类方案，92例中有2例接受了CMF方案。在接受紫杉烷治疗的患者组中，pCR率为29.1%，蒽环类组为6.6%，紫杉烷 + 蒽环类治疗组为12.1%。关于DFS，在谢瓦利埃III级和IV级组之间观察到显著差异（p = 0.006），在pCR组中观察到的事件较少（无显著性差异）。pCR与显著更好的OS相关（p = 0.050）。似乎即使是有限的、常规使用的肿瘤免疫组织化学图谱也能够预测新辅助化疗达到pCR的可能性。三阴性和HER2阳性癌症患者在新辅助化疗后可能达到pCR。
