Choi Misun, Park Yeon Hee, Ahn Jin Seok, Im Young-Hyuck, Nam Seok Jin, Cho Soo Youn, Cho Eun Yoon
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Hematology-Oncology,Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Pathol Transl Med. 2017 Jan;51(1):69-78. doi: 10.4132/jptm.2016.10.05. Epub 2016 Dec 25.
Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) has been associated with favorable clinical outcome in breast cancer patients. However, the possibility that the prognostic significance of pCR differs among various definitions has not been established.
We retrospectively evaluated the pathologic response after NAC in 353 breast cancer patients and compared the prognoses after applying the following different definitions of pCR: ypT0/is, ypT0, ypT0/is ypN0, and ypT0 ypN0.
pCR was significantly associated with improved distant disease-free survival (DDFS) regardless of the definition (ypT0/is, p = .002; ypT0, p = .008; ypT0/is ypN0, p < .001; ypT0 ypN0, p = .003). Presence of tumor deposits of any size in the lymph nodes (LNs; ypN ≥ 0(i+)) was associated with worse DDFS (ypT0 ypN0 vs ypT0 ypN ≥ 0(i+), p = .036 and ypT0/is ypN0 vs ypT0/is ypN ≥ 0(i+), p = .015), and presence of isolated tumor cells was associated with decreased overall survival (OS; ypT0/is ypN0 vs ypT0/is ypN0(i+), p = .013). Residual ductal carcinoma regardless of LN status showed no significant difference in DDFS or OS (DDFS: ypT0 vs ypTis, p = .373 and ypT0 ypN0 vs ypTis ypN0, p = .462; OS: ypT0 vs ypTis, p = .441 and ypT0 ypN0 vs ypTis ypN0, p = .758). In subsequent analysis using ypT0/is ypN0, pCR was associated with improved DDFS and OS in triple-negative tumors (p < .001 and p = .003, respectively).
Based on our study results, the prognosis and rate of pCR differ according to the definition of pCR and ypT0/is ypN0 might be considered a more preferable definition of pCR.
新辅助化疗（NAC）后的病理完全缓解（pCR）与乳腺癌患者良好的临床结局相关。然而，pCR的预后意义在不同定义之间是否存在差异尚未明确。
我们回顾性评估了353例乳腺癌患者NAC后的病理反应，并应用以下不同的pCR定义比较了预后：ypT0/is、ypT0、ypT0/is ypN0和ypT0 ypN0。
无论采用何种定义，pCR均与远处无病生存期（DDFS）的改善显著相关（ypT0/is，p = 0.002；ypT0，p = 0.008；ypT0/is ypN0，p < 0.001；ypT0 ypN0，p = 0.003）。淋巴结（LNs）中存在任何大小的肿瘤沉积物（ypN≥0（i+））与较差的DDFS相关（ypT0 ypN0与ypT0 ypN≥0（i+），p = 0.036；ypT0/is ypN0与ypT0/is ypN≥0（i+），p = 0.015），而存在孤立肿瘤细胞与总生存期（OS）降低相关（ypT0/is ypN0与ypT0/is ypN0（i+），p = 0.013）。无论LN状态如何，残留导管癌在DDFS或OS方面均无显著差异（DDFS：ypT0与ypTis，p = 0.373；ypT0 ypN0与ypTis ypN0，p = 0.462；OS：ypT0与ypTis，p = 0.441；ypT0 ypN0与ypTis ypN0，p = 0.758）。在随后使用ypT0/is ypN0的分析中，pCR与三阴性肿瘤的DDFS和OS改善相关（分别为p < 0.001和p = 0.003）。
根据我们的研究结果，pCR的预后和发生率因pCR的定义而异，ypT0/is ypN0可能被认为是更合适的pCR定义。
