新辅助化疗后腋窝淋巴结状态（经病理完全缓解调整）预测乳腺癌的无病生存差异。
Axillary lymph node status, adjusted for pathologic complete response in breast and axilla after neoadjuvant chemotherapy, predicts differential disease-free survival in breast cancer.
机构信息
Department of Breast Cancer, Cancer Center, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, PR China. ; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, U.S.A.
出版信息
Curr Oncol. 2013 Jun;20(3):e180-92. doi: 10.3747/co.20.1294.
BACKGROUND
Our retrospective study in breast cancer patients evaluated whether integrating subtype and pathologic complete response (pcr) information into axillary lymph node restaging after neoadjuvant chemotherapy (nac) adds significance to its prognostic values.
METHODS
Patients included in the analysis had stage ii or iii disease, with post-nac axillary lymph node dissection (alnd), without sentinel lymph node biopsy before completion of nac, with definitive subtyping data and subtype-oriented adjuvant treatments. The ypN grading system was used to restage axillary lymph node status, and ypN0 was adjusted by pcr in both breast and axilla into ypN0(pcr) and ypN0(non-pcr). Univariate and multivariate survival analyses were performed.
RESULTS
Among the 301 patients analyzed, 145 had tumours that were hormone receptor-positive (hr+) and negative for the human epidermal growth factor receptor (her2-), 101 had tumours that were positive for her2 (her2+), and 55 had tumours that were triple-negative. The rate of pcr in both breast and axilla was 11.7%, 43.6%, and 25.5% respectively for the 3 subtypes. Compared with the non-pcr patients, the pcr patients had better disease-free survival (dfs) and overall survival (os): p = 0.002 for dfs and p = 0.011 for os. In non-pcr patients, dfs and os were similar in the ypN0(non-pcr) and ypN1 subgroups, and in the ypN2 and ypN3 subgroups. We therefore grouped the ypN grading results into ypN0(pcr) (n = 75), ypN0- 1(non-pcr) (n = 175), and ypN2-3 (n = 51). In those groups, the 3-year dfs was 98%, 91%, and 56%, and the 3-year os was 100%, 91%, and 82% respectively. The differences in dfs and os between those three subgroups were significant (all p < 0.05 in paired comparisons). Multivariate Cox regression showed that subtype and ypN staging adjusted by pcr were the only two independent factors predicting dfs.
CONCLUSIONS
Axillary lymph node status after nac, adjusted for pcr in breast and axilla, predicts differential dfs in patients without prior sentinel lymph node biopsy.
背景
我们的回顾性研究在乳腺癌患者中评估了在新辅助化疗（NAC）后整合亚型和病理完全缓解（PCR）信息是否对腋窝淋巴结分期的预后有意义。
方法
分析纳入的患者为 II 期或 III 期疾病，NAC 后行腋窝淋巴结清扫术（ALND），无 NAC 完成前前哨淋巴结活检，有明确的亚型数据和基于亚型的辅助治疗。采用 ypN 分级系统对腋窝淋巴结状态进行分期，PCR 调整乳腺和腋窝的 ypN0 为 ypN0(pcr) 和 ypN0(非 pcr)。进行单变量和多变量生存分析。
结果
在 301 例分析患者中，145 例肿瘤为激素受体阳性（HR+）且人表皮生长因子受体（HER2-）阴性，101 例肿瘤为 HER2 阳性（HER2+），55 例肿瘤为三阴性。3 种亚型的乳腺和腋窝 PCR 率分别为 11.7%、43.6%和 25.5%。与非 PCR 患者相比，PCR 患者的无病生存率（DFS）和总生存率（OS）更好：DFS 为 p = 0.002，OS 为 p = 0.011。在非 PCR 患者中，ypN0（非 PCR）和 ypN1 亚组的 DFS 和 OS 相似，ypN2 和 ypN3 亚组的 DFS 和 OS 相似。因此，我们将 ypN 分级结果分为 ypN0(pcr)（n = 75）、ypN0-1（非 PCR）（n = 175）和 ypN2-3（n = 51）。在这些组中，3 年 DFS 分别为 98%、91%和 56%，3 年 OS 分别为 100%、91%和 82%。三组之间的 DFS 和 OS 差异有统计学意义（配对比较均 p < 0.05）。多变量 Cox 回归显示，亚型和 PCR 调整后的 ypN 分期是预测无前哨淋巴结活检患者 DFS 的唯一两个独立因素。
结论
NAC 后腋窝淋巴结状态，调整乳腺和腋窝的 PCR，预测无前哨淋巴结活检患者的差异 DFS。
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