Department of Breast Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Breast. 2012 Jun;21(3):289-95. doi: 10.1016/j.breast.2011.12.011. Epub 2012 Jan 25.
Although effective regimens have been established for invasive ductal carcinoma-not otherwise specified (IDC), the efficacy and prognosis of other minor types of breast cancer are unknown because of their rareness. The clinicopathological features and prognosis of other minor types concerning the response to neoadjuvant chemotherapy (NAC) were evaluated in this study. A total of 562 patients were classified according to the Japanese and the World Health Organization (WHO) classifications, and the number of IDC and other special types (SP) was 500 and 62. The SP patients had a significantly poorer clinicopathological response to NAC and less breast-conservative therapy than those with IDC. According to the WHO classification, mucinous carcinoma, metaplastic carcinomas and apocrine carcinoma also responded poorly, and patients with metaplastic carcinomas and invasive lobular carcinoma had a significantly poorer prognosis. Despite the poor response to chemotherapy, patients with mucinous carcinoma and apocrine carcinoma had a good prognosis. The response to NAC and the prognosis vary for each histological type. For some types, the prognosis was not related to the clinicopathological response to NAC.
In the treatment of breast cancer, neoadjuvant chemotherapy (NAC) has become the standard treatment modality for downstaging purposes. Although effective regimens have been established for the treatment of invasive ductal carcinoma-not otherwise specified (IDC), the data about the efficacy and prognosis for patients with other minor types of breast cancer are insufficient because of the rareness of these tumors. Defining the relationship between each histological type and the clinicopathological response to NAC is essential to optimizing individualized treatment.
We retrospectively evaluated the clinicopathological features and classification of the histological types based on the Japanese and the World Health Organization (WHO) classifications before and after NAC in 562 patients with primary breast cancer who underwent curative treatment after NAC between 1998 and 2008. The prognosis was estimated for each histological type.
Of the 562 patients, the number of cases of IDC and other special types (SP) was 500 and 62. In the SP group, the clinicopathological response to NAC was significantly poorer, and the patients underwent breast-conservative therapy less frequently than did the IDC patients. According to the WHO classification, mucinous carcinoma, metaplastic carcinomas and apocrine carcinoma responded poorly to NAC. The disease-free survival and overall survival were significantly worse for patients with metaplastic carcinomas (p<0.001 and p<0.001) and with invasive lobular carcinoma (p=0.03 and p<0.001) than other cancers. Despite their poor response to treatment, patients with mucinous carcinoma and apocrine carcinoma had a good prognosis.
The response to standardized NAC and prognosis varies for each histological type. For some types, the prognosis was not associated with the clinicopathological response to NAC. Innovative regimens should therefore be investigated for each histological type to achieve the best response.
在乳腺癌的治疗中，新辅助化疗（NAC）已成为降期治疗的标准治疗方式。尽管已经确立了针对非特殊型浸润性导管癌（IDC）的有效治疗方案，但由于这些肿瘤罕见，因此关于其他少数类型乳腺癌的疗效和预后的数据不足。明确每种组织学类型与 NAC 临床病理反应之间的关系对于优化个体化治疗至关重要。
我们回顾性评估了 562 例接受新辅助化疗（NAC）后行根治性治疗的原发性乳腺癌患者，这些患者于 1998 年至 2008 年期间接受了 NAC。根据日本和世界卫生组织（WHO）分类，我们评估了患者的临床病理特征和组织学类型分类，并在 NAC 前后进行了比较。我们还对每个组织学类型的预后进行了评估。
在这 562 例患者中，IDC 和其他特殊类型（SP）的病例数分别为 500 例和 62 例。在 SP 组中，NAC 的临床病理反应明显较差，接受保乳治疗的频率也低于 IDC 患者。根据 WHO 分类，黏液癌、间变性癌和大汗腺癌对 NAC 反应不佳。间变性癌（p<0.001 和 p<0.001）和浸润性小叶癌（p=0.03 和 p<0.001）患者的无病生存率和总生存率明显更差。尽管这些肿瘤对治疗的反应较差，但黏液癌和大汗腺癌患者的预后较好。
对标准化 NAC 的反应和预后因组织学类型而异。对于某些类型，预后与 NAC 的临床病理反应无关。因此，应为每种组织学类型研究创新的治疗方案，以获得最佳反应。
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