Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Breast Cancer. 2012 Jun;15(2):203-10. doi: 10.4048/jbc.2012.15.2.203. Epub 2012 Jun 28.
Pathologic complete response (pCR) has been suggested as a surrogate prognostic indicator in breast cancer patients treated with neoadjuvant chemotherapy. We assessed whether the likelihood of pCR and survival is associated with the immunohistochemistry-based molecular subtypes.
We retrospectively analyzed the records of 276 patients with breast cancer who received neoadjuvant chemotherapy between January 2000 and January 2010. Patients were classified into four molecular subtypes based on the immunohistochemistry profiles of estrogen receptor, progesterone receptor, and HER2/neu. Logistic regression was used to analyze variables associated with pCR.
The pCR was achieved in 45 patients (16.3%). The triple negative subtype was an independent predictive factor for pCR (odds ratio, 3.21; 95% confidence interval, 1.20-8.56; p=0.020), and the ERBB-2 subtype showed a trend for higher pCR rates (odds ratio, 3.03; 95% confidence interval, 0.93-9.89; p=0.067) compared with the luminal A subtype. In 99 patients with HER2/neu-positive breast cancer, pCR rates were higher in those who received trastuzumab (31.7%) than those treated with conventional chemotherapy regimens (17.2%, p=0.023). The pCR was significantly associated with prolonged progression-free survival (p=0.008). The triple negative subgroup had shorter progression-free survival (p=0.001) and overall survival (p=0.001) than the other subgroups.
We demonstrated that the triple negative and ERBB-2 subtypes are more likely to obtain pCR when neoadjuvant chemotherapy is given, compared to the luminal A subtype. Despite the high pCR rate, the triple negative subtype showed worse survival outcomes, paradoxically, primarily due to patients who had residual disease.
病理完全缓解（pCR）已被提议作为接受新辅助化疗的乳腺癌患者的替代预后指标。我们评估了 pCR 发生的可能性和生存是否与基于免疫组化的分子亚型相关。
我们回顾性分析了 276 例 2000 年 1 月至 2010 年 1 月期间接受新辅助化疗的乳腺癌患者的记录。根据雌激素受体、孕激素受体和 HER2/neu 的免疫组化特征，患者被分为四个分子亚型。使用逻辑回归分析与 pCR 相关的变量。
45 例（16.3%）患者达到 pCR。三阴性亚型是 pCR 的独立预测因素（优势比，3.21；95%置信区间，1.20-8.56；p=0.020），与 luminal A 亚型相比，ERBB-2 亚型显示出更高的 pCR 率趋势（优势比，3.03；95%置信区间，0.93-9.89；p=0.067）。在 99 例 HER2/neu 阳性乳腺癌患者中，接受曲妥珠单抗治疗的患者 pCR 率（31.7%）高于接受常规化疗方案治疗的患者（17.2%，p=0.023）。pCR 与无进展生存期延长显著相关（p=0.008）。与其他亚组相比，三阴性亚组的无进展生存期（p=0.001）和总生存期（p=0.001）更短。
我们证明，与 luminal A 亚型相比，新辅助化疗时，三阴性和 ERBB-2 亚型更有可能获得 pCR。尽管 pCR 率较高，但三阴性亚型的生存结果更差，这主要是由于患者仍有残留疾病。
