Vasudevan Dhanya, Jayalakshmy P S, Kumar Suresh, Mathew Siji
Department of Pathology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala 689101, India.
Department of Pathology, Government Medical College, Thrissur, Kerala 680596, India.
Int J Breast Cancer. 2015;2015:536145. doi: 10.1155/2015/536145. Epub 2015 Nov 30.
Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT) in the setting of locally advanced breast cancer (LABC) can render inoperable tumor (T4, N2/N3) resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response. Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n = 48) were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier's system which graded the responses into pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR). Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2-5 cms) and Bloom Richardson's grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed. Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.
目的。在局部晚期乳腺癌（LABC）中，基于紫杉醇的新辅助化疗方案（NAT）可使无法手术切除的肿瘤（T4，N2/N3）变得可切除。本研究的目的是评估基于紫杉醇的NAT治疗后乳腺和淋巴结中的癌灶情况，以找出与病理反应相对应的患者和肿瘤特征，这些特征可作为评估治疗反应的替代生物标志物。材料与方法。术前评估乳腺癌患者（n = 48）的临床和肿瘤特征。这些患者在接受3个疗程基于紫杉醇的NAT方案后接受改良根治性乳房切除术。使用Chevallier系统研究乳腺和淋巴结中肿瘤的病理反应，该系统将反应分为病理完全缓解（pCR）、病理部分缓解（pPR）和病理无反应（pNR）。结果。我们的研究显示pCR为27.1%，pPR为70.9%。临床小尺寸肿瘤（2 - 5厘米）和Bloom Richardson 1级肿瘤显示pCR。就诊时的平均年龄为50.58岁。79.2%的病例为浸润性导管癌NOS；仅2.1%为浸润性小叶癌，它们对NAT的反应相同。NAT后肿瘤分级没有降低。发现导管原位癌和淋巴管侵犯对化疗耐药。在淋巴结中观察到的组织病理学变化与肿瘤床中发现的相似。讨论与结论。从我们的研究中我们得出结论，肿瘤床的组织病理学检查是评估化疗肿瘤反应的金标准。如先前研究所示，pCR可作为评估肿瘤反应的替代生物标志物。
