Department of Radiation Oncology, Magee-Womens Hospital of UPMC, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213, USA.
Oncology. 2011;80(5-6):341-9. doi: 10.1159/000330203. Epub 2011 Jul 26.
The molecular subtype by hormone receptor status predicts recurrence in the adjuvant setting. Here, we report recurrence patterns by molecular subtype following neoadjuvant chemotherapy (NACT) to identify subgroups prone to recurrence.
We retrospectively analyzed 331 patients receiving NACT plus lumpectomy and whole breast radiation therapy (RT) (n = 155), or mastectomy with (n = 122) or without (n = 50) adjuvant RT. Tumors were classified by immunohistochemical (IHC) surrogate markers into luminal A (strong ER+/PR+; HER2-), luminal B (weak-to-moderate ER+/PR+; HER2-), HER2 (HER2+), and triple-negative/basal subtypes.
The median follow-up was 43 months (range 10-104). The 5-year disease-free survival (DFS) was 71.4, 70.1, 70.4, and 62.1% for luminal A, luminal B, HER2, and basal subtypes, respectively. The 5-year distant recurrence rates were 25.8, 28.7, 28.7, and 35.2%. The 5-year locoregional recurrence rates were 3.8, 1.6, 1.3, and 4.2%. Molecular class (p = 0.003) and pathologic complete response (pCR; p = 0.004) predicted distant recurrence, DFS, and overall survival (OS). Only the omission of adjuvant RT following mastectomy (p = 0.006) predicted locoregional recurrence.
IHC subclassification and pCR predict distant failure, DFS, and OS in the neoadjuvant setting. While not predictive of locoregional recurrence, the total number of events were small. More work is needed to define if molecular class can predict patients at risk for locoregional recurrence.
激素受体状态的分子亚型可预测辅助治疗中的复发。在此，我们报告新辅助化疗（NACT）后分子亚型的复发模式，以确定易复发的亚组。
我们回顾性分析了 331 例接受 NACT 加乳房肿瘤切除术和全乳放射治疗（RT）（n = 155）、或乳房切除术加（n = 122）或不加（n = 50）辅助 RT 的患者。肿瘤通过免疫组织化学（IHC）替代标志物分为 luminal A（强 ER+/PR+；HER2-）、luminal B（弱至中度 ER+/PR+；HER2+）、HER2（HER2+）和三阴性/基底亚型。
中位随访时间为 43 个月（范围 10-104）。luminal A、luminal B、HER2 和基底亚型的 5 年无病生存率（DFS）分别为 71.4%、70.1%、70.4%和 62.1%。5 年远处复发率分别为 25.8%、28.7%、28.7%和 35.2%。5 年局部区域复发率分别为 3.8%、1.6%、1.3%和 4.2%。分子分类（p = 0.003）和病理完全缓解（pCR；p = 0.004）预测远处复发、DFS 和总生存期（OS）。只有乳房切除术时省略辅助 RT（p = 0.006）预测局部区域复发。
IHC 亚分类和 pCR 预测新辅助治疗中的远处失败、DFS 和 OS。虽然不能预测局部区域复发，但总的事件数较少。需要进一步研究以确定分子分类是否可以预测局部区域复发的风险。
