肿瘤生物学预测局部晚期乳腺癌患者新辅助化疗的病理完全缓解。
Tumor Biology Predicts Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients Presenting with Locally Advanced Breast Cancer.
机构信息
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
出版信息
Ann Surg Oncol. 2017 Dec;24(13):3896-3902. doi: 10.1245/s10434-017-6085-y. Epub 2017 Sep 15.
BACKGROUND
Neoadjuvant chemotherapy (NAC) is used to convert patients with inoperable locally advanced breast cancer (LABC) to operability, but has not traditionally been used to avoid mastectomy or axillary dissection in this subset.
OBJECTIVE
The purpose of this study was to determine the rates of pathologic complete response (pCR) in LABC patients, and identify factors predictive of pCR to determine if responding patients might be suitable for limited surgery.
METHODS
From 2006 to 2016, 1522 patients received NAC followed by surgery; 321 had advanced disease in the breast (cT4) and/or in the nodes (cN2/N3). pCR rates were assessed by T and N stage, and receptor subtype.
RESULTS
Of 321 LABC patients, 223 were cT4, 77 were cN2, and 82 were cN3. Forty-three percent were hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative (HR+/HER2-), 23% were triple negative, and 34% were HER2+. The overall pCR rate was 25% and differed by receptor subtype (HR+/HER2- 7%, triple negative 23%, HER2+ 48%; p < 0.001). Breast pCR occurred in 27% of patients and was similar in T4 versus non-T4 disease (29% vs. 22%; p = 0.26). Nodal pCR was achieved in 38% of cN+ patients and did not differ by nodal stage (cN1 43%, cN2 36%, cN3 32%; p = 0.23). Nodal pCR was significantly more common than breast pCR (p = 0.014) across all tumor subtypes. Receptor subtype was the only predictor of overall pCR (p < 0.001).
CONCLUSION
In patients with LABC, pCR after NAC was seen in 25%, and did not differ by T or N stage. Tumor biology, but not extent of disease, predicted pCR. Studies assessing the feasibility of surgical downstaging with NAC in LABC patients are warranted.
背景
新辅助化疗（NAC）用于使不可手术的局部晚期乳腺癌（LABC）患者能够进行手术，但传统上并未用于避免该亚组患者进行乳房切除术或腋窝清扫术。
目的
本研究旨在确定 LABC 患者的病理完全缓解（pCR）率，并确定预测 pCR 的因素，以确定是否可以对有反应的患者进行有限手术。
方法
2006 年至 2016 年，1522 例患者接受 NAC 治疗后进行手术；321 例患者乳房（cT4）和/或淋巴结（cN2/N3）存在晚期疾病。通过 T 和 N 分期以及受体亚型评估 pCR 率。
结果
321 例 LABC 患者中，223 例为 cT4，77 例为 cN2，82 例为 cN3。43%为激素受体（HR）阳性/人表皮生长因子受体 2（HER2）阴性（HR+/HER2-），23%为三阴性，34%为 HER2+。总体 pCR 率为 25%，且根据受体亚型而有所不同（HR+/HER2-为 7%，三阴性为 23%，HER2+为 48%；p<0.001）。32%的患者出现乳腺 pCR，且 T4 与非 T4 疾病之间无差异（29%与 22%；p=0.26）。cN+患者中有 38%实现了淋巴结 pCR，且与淋巴结分期无关（cN1 为 43%，cN2 为 36%，cN3 为 32%；p=0.23）。在所有肿瘤亚型中，淋巴结 pCR 均显著高于乳腺 pCR（p=0.014）。受体亚型是总体 pCR 的唯一预测因素（p<0.001）。
结论
在 LABC 患者中，NAC 后的 pCR 发生率为 25%，且与 T 或 N 分期无关。肿瘤生物学而非疾病范围可预测 pCR。需要进行评估 NAC 能否使 LABC 患者进行手术降期的可行性的研究。
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