新辅助化疗后出现脉管侵犯与乳腺癌不良预后密切相关。
Lymphovascular invasion after neoadjuvant chemotherapy is strongly associated with poor prognosis in breast carcinoma.
机构信息
Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France.
Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.
出版信息
Breast Cancer Res Treat. 2018 Jun;169(2):295-304. doi: 10.1007/s10549-017-4610-0. Epub 2018 Jan 27.
PURPOSE
Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC).
METHODS
The association between LVI and survival was evaluated in a cohort of BC patients treated by NAC between 2002 and 2011. Five post-NAC prognostic scores (ypAJCC, RCB, CPS, CPS + EG and Neo-Bioscore) were evaluated and compared with or without the addition of LVI.
RESULTS
Out of 1033 tumors, LVI was present on surgical specimens in 29.2% and absent in 70.8% of the cases. Post-NAC LVI was associated with impaired disease-free survival (DFS) (HR 2.54; 95% CI 1.96-3.31; P < 0.001), and the magnitude of this effect depended on BC subtype (P = 0.003), (luminal BC: HR 1.83; P = 0.003; triple negative BC: HR 3.73; P < 0.001; HER2-positive BC: HR 6.21; P < 0.001). Post-NAC LVI was an independent predictor of local relapse, distant metastasis, and overall survival; and increased the accuracy of all five post-NAC prognostic scoring systems.
CONCLUSIONS
Post-NAC LVI is a strong independent prognostic factor that: (i) should be systematically reported in pathology reports; (ii) should be used as stratification factor after NAC to propose inclusion in second-line trials or adjuvant treatment; (iii) should be included in post-NAC scoring systems.
目的
很少有研究评估新辅助化疗（NAC）后乳腺癌（BC）中存在脉管侵犯（LVI）的预后价值。
方法
本研究评估了 2002 年至 2011 年间接受 NAC 治疗的 BC 患者队列中 LVI 与生存之间的关联。评估了 5 种 NAC 后预后评分（ypAJCC、RCB、CPS、CPS+EG 和 Neo-Bioscore），并比较了有无 LVI 对这些评分的影响。
结果
在 1033 例肿瘤中，手术标本中存在 LVI 的比例为 29.2%，不存在 LVI 的比例为 70.8%。NAC 后 LVI 与无病生存（DFS）受损相关（HR 2.54；95%CI 1.96-3.31；P<0.001），这种影响的程度取决于 BC 亚型（P=0.003），（管腔 BC：HR 1.83；P=0.003；三阴性 BC：HR 3.73；P<0.001；HER2 阳性 BC：HR 6.21；P<0.001）。NAC 后 LVI 是局部复发、远处转移和总生存的独立预测因素；并提高了所有 5 种 NAC 后预后评分系统的准确性。
结论
NAC 后 LVI 是一个强大的独立预后因素，（i）应系统地报告在病理报告中；（ii）应在 NAC 后作为分层因素，以建议纳入二线试验或辅助治疗；（iii）应纳入 NAC 后评分系统。
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