肿瘤生物学及对化疗的反应影响接受新辅助化疗的淋巴结阳性乳腺癌患者的乳腺癌特异性生存：来自美国外科医师学会肿瘤学组Z1071（联盟）的长期随访
Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: Long-term Follow-up From ACOSOG Z1071 (Alliance).
作者信息
Boughey Judy C, Ballman Karla V, McCall Linda M, Mittendorf Elizabeth A, Symmans William Fraser, Julian Thomas B, Byrd David, Hunt Kelly K
机构信息
*Mayo Clinic, Rochester, MN †Alliance Statistics and Data Center, Weill Medical College of Cornell University, New York, NY ‡Alliance Statistics and Data Center, Duke University, Durham, NC §The University of Texas MD Anderson Cancer Center, Houston, TX ¶NRG Oncology and The Allegheny Health Network, Pittsburgh, PA ||SWOG and University of Washington Medical Center, Seattle, WA.
出版信息
Ann Surg. 2017 Oct;266(4):667-676. doi: 10.1097/SLA.0000000000002373.
BACKGROUND
Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy.
METHODS
ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed.
RESULTS
Median follow-up of 701 eligible patients was 4.1 years (0.4-6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8%; 95% confidence interval (CI): 87.7-98.6], followed by hormone receptor-positive/HER2-negative (80.4%; 95% CI: 73.2-85.9) and lowest in triple-negative (TNBC) (74.8%; 95% CI: 66.6-81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95% CI: 78.8-95.3 vs 65.8%; 95% CI: 54.5-74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4-84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0%; 95% CI: 83.6-99.1 vs 95.8%; 95% CI: 81.4-99.1; P = 0.77).
CONCLUSIONS
In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95% in HER2-positive disease independent of chemotherapy response.
背景
淋巴结阳性乳腺癌女性患者复发风险高。我们评估了在接受新辅助化疗的淋巴结阳性队列中，近似肿瘤亚型及化疗反应对长期预后的影响。
方法
美国外科医师学会肿瘤学组（ACOSOG）Z1071研究纳入了2009年至2011年接受新辅助化疗的cT0 - 4N1 - 2乳腺癌患者。分析了影响乳腺癌特异性生存（BCSS）和总生存（OS）的因素。
结果
701例符合条件患者的中位随访时间为4.1年（0.4 - 6.5年）。90例患者（12.8%）死于乳腺癌。近似亚型和化疗反应与BCSS及OS显著相关（P < 0.0001）。达到病理完全缓解（pCR）的患者BCSS和OS最高（分别为P < 0.0001和P < 0.0001）。人表皮生长因子受体2（HER2）阳性疾病的5年BCSS最高[95.8%；95%置信区间（CI）：87.7 - 98.6]，其次是激素受体阳性/HER2阴性（80.4%；95% CI：73.2 - 85.9），三阴性乳腺癌（TNBC）最低（74.8%；95% CI：66.6 - 81.2；P < 0.0001）。OS也呈现类似模式。在TNBC患者（n = 174）中，pCR患者的5年BCSS高于有残留病灶者（89.8%；95% CI：78.8 - 95.3 vs 65.8%；95% CI：54.5 - 74.9；P = 0.0013）。在激素受体阳性/HER2阴性疾病（n = 318）中，pCR患者的BCSS为100%，有残留病灶者为78.3%（95% CI：70.4 - 84.3）（P = 0.018）。在HER2阳性疾病（n = 204）中，pCR和有残留病灶者之间无差异（96.0%；95% CI：83.6 - 99.1 vs 95.8%；95% CI：81.4 - 99.1；P = 0.77）。
结论
在接受新辅助化疗的淋巴结阳性乳腺癌患者中，BCSS和OS与近似亚型及化疗反应相关，且在有残留病灶的TNBC患者中最低。HER2阳性疾病的5年BCSS>95%，与化疗反应无关。
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