Osako Tomo, Horii Rie, Matsuura Masaaki, Domoto Kaoru, Ide Yoshimi, Miyagi Yumi, Takahashi Shunji, Ito Yoshinori, Iwase Takuji, Akiyama Futoshi
Divisions of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
J Cancer Res Clin Oncol. 2010 Sep;136(9):1431-8. doi: 10.1007/s00432-010-0798-7. Epub 2010 Feb 9.
We reported that breast cancers achieving pathological complete response (pCR) or progressive disease (PD) to neoadjuvant chemotherapy (NAC), which are considered exact opposites on the chemosensitivity spectrum, have certain clinicopathological features in common. To determine the highly sensitive and highly resistant subsets to cytotoxic chemotherapy, we evaluated predictive factors for pCR and PD to NAC, and assessed the similarities in these factors.
Subjects comprised 300 women with 304 stage II or III breast cancers treated with chemotherapy that was anthracycline-based, taxane, or both, followed by surgery between 2007 and 2008. We retrospectively evaluated pre-NAC clinicopathological features including chemotherapy regimen, clinical T stage, nuclear grade (NG), hormone receptor (HR) status, and human epidermal growth factor receptor-2 (HER2) status in pCR and PD, using univariate chi(2) testing and multivariate logistic regression analyses.
Of 304 tumors, 30 (10%) achieved pCR and 22 (7%) showed PD to NAC. Multivariate analysis demonstrated that anthracycline plus taxane chemotherapy (P = 0.006), NG3 (P = 0.006), HR-negativity (P = 0.013), and HER2-positivity (P = 0.010) were significant predictors of pCR, and T3-4 (P = 0.002) and NG3 (P = 0.010) were significant predictors of PD.
High-grade breast cancers include both highly sensitive and highly resistant subsets to cytotoxic chemotherapy. Three factors can help discriminate between these subsets. HR-negative and HER2-positive can be predictive of high chemosensitivity. Advanced primary tumor stage can be predictive of high chemoresistance.
我们曾报道，对新辅助化疗（NAC）达到病理完全缓解（pCR）或疾病进展（PD）的乳腺癌，这在化疗敏感性谱上被认为是完全相反的情况，却具有某些共同的临床病理特征。为了确定对细胞毒性化疗高度敏感和高度耐药的亚组，我们评估了pCR和PD对NAC的预测因素，并评估了这些因素的相似性。
研究对象包括300名患有II期或III期乳腺癌的女性，她们在2007年至2008年间接受了以蒽环类、紫杉烷或两者为基础的化疗，随后接受手术。我们回顾性评估了NAC前的临床病理特征，包括化疗方案、临床T分期、核分级（NG）、激素受体（HR）状态和人表皮生长因子受体2（HER2）状态，采用单因素卡方检验和多因素逻辑回归分析来分析pCR和PD情况。
在304个肿瘤中，30个（10%）达到pCR，22个（7%）对NAC显示PD。多因素分析表明，蒽环类加紫杉烷化疗（P = 0.006）、NG3（P = 0.006）、HR阴性（P = 0.013）和HER2阳性（P = 0.010）是pCR的显著预测因素，T3 - 4（P = 0.002）和NG3（P = 0.010）是PD的显著预测因素。
高级别乳腺癌包括对细胞毒性化疗高度敏感和高度耐药的亚组。三个因素有助于区分这些亚组。HR阴性和HER2阳性可预测高化疗敏感性。原发性肿瘤晚期可预测高化疗耐药性。
