Mukai Hirofumi, Arihiro Koji, Shimizu Chikako, Masuda Norikazu, Miyagi Yumi, Yamaguchi Takeshi, Yoshida Takashi
Division of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan.
Breast Cancer. 2016 Jan;23(1):73-77. doi: 10.1007/s12282-015-0640-9. Epub 2015 Sep 30.
Neoadjuvant chemotherapy (NAC) is one of the standard treatment for patients with operable and locally advanced breast cancer. Pathological response after NAC has been assessed according to the Japanese Breast Cancer Society (JBCS) classification in Japan. This classification that was first established in 1998 and revised in 2007 has been used in routine clinical practice in Japan. In the present study, we investigated whether the assessment of pathological response according to this classification could stratify the long-term outcome of patients with breast cancer.
Patients with breast cancer who had received neoadjuvant chemotherapy between January 2003 and December 2005 in 6 hospitals participating in this study were identified. Patients whose response was judged to be Grade 2 was reassessed into Grades 2a and 2b according to the updated JBCS classification revised in 2007. Then, the association of pathological response and recurrence-free survival (RFS) was analyzed.
635 patients received NAC and 154 relapses (24 %) were observed during a median follow-up of 41.5 months (range 4.2-69.5 months). There was a statistically significant difference in RFS among each pathological response. 5-year RFS of patients with Grade 3 without residual ductal carcinoma in situ was 94 %. 5-year RFS were 88 % in Grade 3, 95 % in Grade 2b, 80 % in Grade 2a, 73 % in Grade 1b, 67 % in Grade 1a, 59 % in Grade 0, respectively.
An outcome could be stratified by assessing tumor burden following NAC according to the JBCS classification.
新辅助化疗（NAC）是可手术及局部晚期乳腺癌患者的标准治疗方法之一。在日本，NAC后的病理反应是根据日本乳腺癌学会（JBCS）分类进行评估的。该分类于1998年首次制定，并于2007年修订，已在日本的常规临床实践中使用。在本研究中，我们调查了根据该分类评估病理反应是否可以对乳腺癌患者的长期预后进行分层。
确定了2003年1月至2005年12月期间在参与本研究的6家医院接受新辅助化疗的乳腺癌患者。根据2007年修订的最新JBCS分类，将反应被判定为2级的患者重新评估为2a级和2b级。然后，分析病理反应与无复发生存期（RFS）的关联。
635例患者接受了NAC，在中位随访41.5个月（范围4.2 - 69.5个月）期间观察到154例复发（24%）。各病理反应之间的RFS存在统计学显著差异。3级且无残留导管原位癌患者的5年RFS为94%。3级患者的5年RFS分别为88%，2b级为95%，2a级为80%，1b级为73%，1a级为67%，0级为59%。
根据JBCS分类评估NAC后的肿瘤负荷可以对预后进行分层。
