University of California San Francisco, 1600 Divisadero Street, Box 1710, San Francisco, CA 94115, USA.
Breast Cancer Res Treat. 2012 Apr;132(3):1049-62. doi: 10.1007/s10549-011-1895-2. Epub 2011 Dec 25.
Neoadjuvant chemotherapy for breast cancer allows individual tumor response to be assessed depending on molecular subtype, and to judge the impact of response to therapy on recurrence-free survival (RFS). The multicenter I-SPY 1 TRIAL evaluated patients with ≥ 3 cm tumors by using early imaging and molecular signatures, with outcomes of pathologic complete response (pCR) and RFS. The current analysis was performed using data from patients who had molecular profiles and did not receive trastuzumab. The various molecular classifiers tested were highly correlated. Categorization of breast cancer by molecular signatures enhanced the ability of pCR to predict improvement in RFS compared to the population as a whole. In multivariate analysis, the molecular signatures that added to the ability of HR and HER2 receptors, clinical stage, and pCR in predicting RFS included 70-gene signature, wound healing signature, p53 mutation signature, and PAM50 risk of recurrence. The low risk signatures were associated with significantly better prognosis, and also identified additional patients with a good prognosis within the no pCR group, primarily in the hormone receptor positive, HER-2 negative subgroup. The I-SPY 1 population is enriched for tumors with a poor prognosis but is still heterogeneous in terms of rates of pCR and RFS. The ability of pCR to predict RFS is better by subset than it is for the whole group. Molecular markers improve prediction of RFS by identifying additional patients with excellent prognosis within the no pCR group.
新辅助化疗可用于评估乳腺癌患者的个体肿瘤反应,根据分子亚型进行判断,并评估治疗反应对无复发生存率(RFS)的影响。多中心 I-SPY 1 试验通过早期影像学和分子特征评估了≥3cm 肿瘤的患者,评估了病理完全缓解(pCR)和 RFS 的结果。本分析使用了未接受曲妥珠单抗治疗且具有分子特征的患者数据。测试的各种分子分类器高度相关。与整个人群相比,基于分子特征的乳腺癌分类提高了 pCR 预测 RFS 改善的能力。在多变量分析中,除了 HR 和 HER2 受体、临床分期和 pCR 之外,可增强预测 RFS 能力的分子特征包括 70 基因特征、伤口愈合特征、p53 突变特征和 PAM50 复发风险。低风险特征与更好的预后显著相关,并且还在无 pCR 组内识别出了更多预后良好的患者,主要是在激素受体阳性、HER-2 阴性亚组中。I-SPY 1 人群中肿瘤预后较差,但在 pCR 和 RFS 方面仍存在异质性。pCR 预测 RFS 的能力在亚组中比在整个组中更好。分子标志物通过在无 pCR 组内识别出具有良好预后的更多患者,从而提高了对 RFS 的预测能力。