Tőkés Tímea, Szentmártoni Gyöngyvér, Torgyík László, Kajáry Kornélia, Lengyel Zsolt, Györke Tamás, Molnár Béla Á, Tőkés Anna-Mária, Kulka Janina, Dank Magdolna
Magdolna Dank, Semmelweis University, 1st Dept. of Internal Medicine, Oncological Division, Tömő street 25-29. 4th floor, Budapest, Hungary, H- 1083.,
Croat Med J. 2015 Apr;56(2):128-38. doi: 10.3325/cmj.2015.56.128.
To evaluate (I) trastuzumab-containing primary systemic therapy (PST) in human epidermal growth factor receptor 2 (Her2) overexpressing breast carcinomas.; (II) compare the patients who achieved and those who did not achieve pathological complete remission (pCR), and (III) analyze the accuracy of different clinical-imaging modalities in tumor response monitoring.
188 patients who received PST between 2008 and 2014 were reviewed and 43 Her2 overexpressing breast cancer patients (28 Luminal B/Her2-positive and 15 Her2-positive) were enrolled. 26 patients received mostly taxane-based PST without trastuzumab (Group 1) and 17 patients received trastuzumab-containing PST (Group 2). We compared the concordance between pCR and complete remission (CR) defined by breast-ultrasound, CR defined by standard 18F-fluoro-deoxy-glucose positron emission tomography and computerized tomography (FDG-PET/CT) criteria (Method 1) and CR defined by a novel, breast cancer specific FDG-PET/CT criteria (Method 2). Sensitivity (sens), specificity (spec), and positive (PPV) and negative predictive values (NPV) were calculated.
Ten patients (38.5%) in Group 1 and eight (47%) in Group 2 achieved pCR. pCR was significantly more frequent in Her2-positive than in Luminal B/Her2-positive tumors in both Group 1: (P=0.043) and Group 2: (P=0.029). PET/CT evaluated by the breast cancer specific criteria (Method 2) differentiated pCR from non-pCR more accurately in both groups (Group 1: sens=77.8%, spec=%, PPV=100%, NPV=71.4%; Group 2: sens=87.5%, spec=62.5%, PPV=70%, NPV=83.3%) than standard PET/CT criteria (Method 1) (Group 1: sens=22.2% spec=100% PPV=100% NPV=41.7%; in Group 2: sens=37.5%, spec=87.5%, PPV=75% NPV=58.3%) or breast ultrasound (Group 1, sens=83.3% spec=25% PPV=62.5% NPV=50%; Group 2, sens=100% spec=12.5% PPV=41.6% NPV=100%).
The benefit of targeted treatment with trastuzumab-containing PST in Her2 overexpressing breast cancer was defined in terms of pCR rate. Luminal B/Her2-positive subtype needs further subdivision to identify patients who would benefit from PST. Combined evaluation of tumor response by our novel, breast cancer specific FDG-PET/CT criteria accurately differentiated pCR from non-pCR patients.
评估（I）含曲妥珠单抗的原发性全身治疗（PST）在人表皮生长因子受体2（Her2）过表达乳腺癌中的应用；（II）比较达到和未达到病理完全缓解（pCR）的患者；（III）分析不同临床成像方式在肿瘤反应监测中的准确性。
回顾2008年至2014年间接受PST的188例患者，纳入43例Her2过表达乳腺癌患者（28例Luminal B/Her2阳性和15例Her2阳性）。26例患者主要接受不含曲妥珠单抗的紫杉类PST（第1组），17例患者接受含曲妥珠单抗的PST（第2组）。我们比较了pCR与乳腺超声定义的完全缓解（CR）、标准18F-氟脱氧葡萄糖正电子发射断层扫描和计算机断层扫描（FDG-PET/CT）标准定义的CR（方法1）以及新型乳腺癌特异性FDG-PET/CT标准定义的CR（方法2）之间的一致性。计算敏感性（sens）、特异性（spec）、阳性预测值（PPV）和阴性预测值（NPV）。
第1组10例患者（38.5%）和第2组8例患者（47%）达到pCR。在第1组（P = 0.043）和第2组（P = 0.029）中，Her2阳性肿瘤的pCR发生率均显著高于Luminal B/Her2阳性肿瘤。两组中，采用乳腺癌特异性标准（方法2）评估的PET/CT在区分pCR和非pCR方面比标准PET/CT标准（方法1）（第1组：sens = 22.2%，spec = 100%，PPV = 100%，NPV = 41.7%；第2组：sens = 37.5%，spec = 87.5%，PPV = 75%，NPV = 58.3%）或乳腺超声（第1组，sens = 83.3%，spec =
