Department of Breast Surgery, St James's University Hospital, Leeds, UK.
Department of Pathology, St James's University Hospital, Leeds, UK.
Br J Surg. 2017 Aug;104(9):1177-1187. doi: 10.1002/bjs.10544. Epub 2017 Jun 28.
Neoadjuvant chemotherapy (NACT) is increasingly being offered to patients with breast cancer. No survival benefit has been demonstrated for NACT, but it may serve to reduce tumour size and improve prognosis through the attainment of a pathological complete response (pCR). The role and mode of MRI monitoring during NACT remain unclear.
Patients managed with NACT at a UK centre over 7 years were studied using a prospectively maintained database, which also included details of MRI. Clinicopathological and radiological predictors of NACT response were analysed in a univariable setting and survival analysis was undertaken using the Kaplan-Meier method.
A total of 278 patients underwent surgery following NACT, of whom 200 (71·9 per cent) had residual invasive disease and 78 (28·1 per cent) achieved a pCR. Attaining a pCR improved survival significantly compared with that of patients with residual invasive disease (mean 77·1 versus 66·0 months; P = 0·004) and resulted in significantly fewer recurrences (6·0 versus 24·3 per cent; P = 0·001). The pCR rate varied significantly among molecular subgroups of breast cancer (P < 0·001): luminal A, 6 per cent; luminal B/human epidermal growth factor 2 receptor (Her2)-negative, 21 per cent; luminal B/Her2-positive, 35 per cent, Her2-positive/non-luminal, 72 per cent; and triple-negative breast cancer (TNBC), 32 per cent. High-grade disease (G3) correlated with an increased rate of pCR. A radiological response seen on the mid-treatment MRI was predictive of pCR (sensitivity 77·6 per cent, but specificity only 53·3 per cent), as was complete radiological response at final MRI (specificity 97·6 per cent, but sensitivity only 32·2 per cent).
NACT allows identification of patient subgroups within TNBC and Her2-positive cohorts with a good prognosis. MRI can be used to identify patients who are responding to treatment.
新辅助化疗（NACT）越来越多地应用于乳腺癌患者。虽然 NACT 并未显示出生存获益，但它可能通过获得病理完全缓解（pCR）来缩小肿瘤大小并改善预后。在 NACT 期间，MRI 监测的作用和方式仍不清楚。
通过前瞻性维护的数据库对英国中心 7 年内接受 NACT 治疗的患者进行研究，该数据库还包括 MRI 的详细信息。在单变量环境中分析了 NACT 反应的临床病理和影像学预测因素，并使用 Kaplan-Meier 方法进行了生存分析。
共有 278 例患者在 NACT 后接受了手术，其中 200 例（71.9%）有残留浸润性疾病，78 例（28.1%）达到 pCR。与残留浸润性疾病患者相比，达到 pCR 显著改善了生存（平均 77.1 与 66.0 个月；P=0.004），且复发率显著降低（6.0%与 24.3%；P=0.001）。乳腺癌的分子亚组之间 pCR 率差异显著（P<0.001）：Luminal A 型为 6%；Luminal B/人表皮生长因子受体 2（Her2）阴性型为 21%；Luminal B/Her2 阳性型为 35%；Her2 阳性/非 Luminal 型为 72%；三阴性乳腺癌（TNBC）为 32%。高级别疾病（G3）与 pCR 率增加相关。中期 MRI 上的放射学反应与 pCR 相关（敏感性为 77.6%，但特异性仅为 53.3%），最终 MRI 上的完全放射学反应也是如此（特异性为 97.6%，但敏感性仅为 32.2%）。
NACT 可识别 TNBC 和 Her2 阳性患者亚组，预后良好。MRI 可用于识别对治疗有反应的患者。
