Division of Surgical Oncology, Department of Surgery, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC, USA.
Ann Surg Oncol. 2011 Oct;18(10):2851-7. doi: 10.1245/s10434-011-1665-8. Epub 2011 Mar 26.
Gene expression studies have identified distinct breast cancer subtypes, including luminal A, luminal B, Her2-enriched, and Basal-like, which differ in survival. The impact of subtypes on locoregional recurrence (LRR) after neoadjuvant chemotherapy for locally advanced breast cancer is unknown.
A total of 149 patients with stage II and III breast cancer with known ER, PR, and HER2 who underwent neoadjuvant chemotherapy from 1991 to 2005 were analyzed. We used clinical assays to distinguish luminal A (ER or PR+/HER2-, n = 55), luminal B (ER or PR+/HER2+, n = 25), HER2 (ER and PR-/HER2+, n = 20), and Basal-like (ER, PR, and HER2-, n = 49) subtypes. Covariates associated with LRR were evaluated by logistic regression and differences between subtypes tested using Wald χ(2).
Median follow-up was 55 months. Forty-nine (33%) patients had breast conservation (BCT) with radiation, 82 (55%) had a mastectomy with radiation, and 18 (12%) had a mastectomy alone. Eighty-eight (59%) were clinically node positive. A pathologic complete response was seen in 39 (26%) patients. LRR was identified in 11 (7%) patients: 2 after BCT (4%) and 9 after mastectomy (9%). LRR rates by subtype are as follows: luminal A 2 of 55 (4%), luminal B 1 of 25 (4%), Her2 1 of 20 (5%), and basal-like 7 of 49 (14%). Compared with all other subtypes, basal-like patients were more likely to have a LRR (7/49 (14%) vs. 4/100 (4%), p = 0.03).
Molecular subtype predicts LRR with basal-like patients more likely to develop LRR. These patients may be candidates for investigation with novel chemotherapy regimens and radiation sensitizing agents, which may offer improvement in local control.
基因表达研究已经确定了不同的乳腺癌亚型，包括 luminal A、luminal B、Her2 富集型和基底样型，它们在生存率上有所不同。目前尚不清楚亚型对局部晚期乳腺癌新辅助化疗后局部区域复发（LRR）的影响。
对 1991 年至 2005 年间接受新辅助化疗的 149 例 II 期和 III 期乳腺癌患者的 ER、PR 和 HER2 进行了分析。我们使用临床检测来区分 luminal A（ER 或 PR+/HER2-，n=55）、luminal B（ER 或 PR+/HER2+，n=25）、HER2（ER 和 PR-/HER2+，n=20）和基底样（ER、PR 和 HER2-，n=49）亚型。通过 logistic 回归评估与 LRR 相关的协变量，并使用 Wald χ(2) 检验亚型之间的差异。
中位随访时间为 55 个月。49 例（33%）患者行保乳（BCT）加放疗，82 例（55%）行乳房切除术加放疗，18 例（12%）行单纯乳房切除术。88 例（59%）为临床淋巴结阳性。39 例（26%）患者达到病理完全缓解。11 例（7%）患者出现 LRR：BCT 后 2 例（4%），乳房切除术后 9 例（9%）。各亚型 LRR 发生率如下：luminal A 为 55 例中的 2 例（4%），luminal B 为 25 例中的 1 例（4%），Her2 为 20 例中的 1 例（5%），基底样型为 49 例中的 7 例（14%）。与其他所有亚型相比，基底样型患者发生 LRR 的可能性更大（7/49（14%）比 4/100（4%），p=0.03）。
分子亚型预测 LRR，基底样型患者更有可能发生 LRR。这些患者可能是新型化疗方案和放射增敏剂的候选者，这可能有助于提高局部控制率。
