Lim Siew Kuan, Lee Moo Hyun, Park In Hae, You Ji Young, Nam Byung-Ho, Kim Byeong Nam, Ro Jungsil, Lee Keun Seok, Jung So-Youn, Kwon Young Mee, Lee Eun Sook
Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea ; Breast Service, Department of General Surgery, Changi General Hospital, Singapore.
Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Cancer Res Treat. 2016 Jan;48(1):133-41. doi: 10.4143/crt.2014.262. Epub 2015 Apr 7.
The aim of this study was to examine molecular subtype conversions in patients who underwent neoadjuvant chemotherapy (NAC) and analyze their clinical implications.
We included consecutive breast cancer patients who received NAC at the National Cancer Center, Korea, between August 2002 and June 2011, and had available data on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) receptor status prior to NAC. Molecular subtypes, hormone receptor (HR) status, and ER and PR Allred scores before and after NAC were compared, and the long-term outcomes were analyzed.
Of 322 patients, 32 (9.9%) achieved a pathologic complete response after NAC. HR+/HER2- tumors tended to convert into triple negative (TN) tumors (10.3%), whereas 34.6% of TN tumors gained HR positivity to become HR+/HER2- tumors. Clinical outcomes of molecular subtype conversion groups were compared against patients who remained as HR+/HER2- throughout. The HR+/HER2- to TN group had significantly poorer recurrence-free survival (RFS) (hazard ratio, 3.54; 95% confidence interval [CI], 1.60 to 7.85) and overall survival (OS) (hazard ratio, 3.73; 95% CI, 1.34 to 10.38). Patients who remained TN throughout had the worst outcomes (for RFS: hazard ratio, 3.70; 95% CI, 1.86 to 7.36; for OS: hazard ratio, 5.85; 95% CI, 2.53 to 13.51), while those who converted from TN to HR+/HER2-showed improved comparable survival outcomes.
Molecular subtypes of breast cancers changed frequently after NAC, resulting in different tumor prognostication. Tumor subtyping should be repeated after NAC in patients with breast cancer.
本研究旨在检测接受新辅助化疗（NAC）患者的分子亚型转换情况，并分析其临床意义。
我们纳入了2002年8月至2011年6月期间在韩国国立癌症中心接受NAC的连续性乳腺癌患者，且这些患者在NAC前有关于雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子2（HER2）受体状态的可用数据。比较了NAC前后的分子亚型、激素受体（HR）状态以及ER和PR的艾尔雷德评分，并分析了长期预后情况。
在322例患者中，32例（9.9%）在NAC后达到病理完全缓解。HR+/HER2-肿瘤倾向于转化为三阴性（TN）肿瘤（10.3%），而34.6%的TN肿瘤获得HR阳性，成为HR+/HER2-肿瘤。将分子亚型转换组的临床结局与全程保持HR+/HER2-状态的患者进行比较。HR+/HER2-转TN组的无复发生存期（RFS）显著更差（风险比，3.54；95%置信区间[CI]，1.60至7.85），总生存期（OS）也显著更差（风险比，3.73；95%CI，1.34至10.38）。全程保持TN状态的患者预后最差（RFS：风险比，3.70；95%CI，1.86至7.36；OS：风险比，5.85；95%CI，2.53至13.51），而从TN转化为HR+/HER2-的患者显示出改善的类似生存结局。
NAC后乳腺癌的分子亚型频繁变化，导致不同的肿瘤预后。乳腺癌患者在NAC后应重复进行肿瘤亚型分类。
