Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Br J Surg. 2018 Apr;105(5):535-543. doi: 10.1002/bjs.10755. Epub 2018 Feb 21.
Patients with triple-negative breast cancer (TNBC) and a pathological complete response (pCR) after neoadjuvant chemotherapy may be suitable for non-surgical management. The goal of this study was to identify baseline clinicopathological variables that are associated with residual disease, and to evaluate the effect of neoadjuvant chemotherapy on both the invasive and ductal carcinoma in situ (DCIS) components in TNBC.
Patients with TNBC treated with neoadjuvant chemotherapy followed by surgical resection were identified. Patients with a pCR were compared with those who had residual disease in the breast and/or lymph nodes. Clinicopathological variables were analysed to determine their association with residual disease.
Of the 328 patients, 36·9 per cent had no residual disease and 9·1 per cent had residual DCIS only. Patients with residual disease were more likely to have malignant microcalcifications (P = 0·023) and DCIS on the initial core needle biopsy (CNB) (P = 0·030). Variables independently associated with residual disease included: DCIS on CNB (odds ratio (OR) 2·46; P = 0·022), T2 disease (OR 2·40; P = 0·029), N1 status (OR 2·03; P = 0·030) and low Ki-67 (OR 2·41; P = 0·083). Imaging after neoadjuvant chemotherapy had an accuracy of 71·7 (95 per cent c.i. 66·3 to 76·6) per cent and a negative predictive value of 76·9 (60·7 to 88·9) per cent for identifying residual disease in the breast and lymph nodes. Neoadjuvant chemotherapy did not eradicate the DCIS component in 55 per cent of patients.
The presence of microcalcifications on imaging and DCIS on initial CNB are associated with residual disease after neoadjuvant chemotherapy in TNBC. These variables can aid in identifying patients with TNBC suitable for inclusion in trials evaluating non-surgical management after neoadjuvant chemotherapy.
接受新辅助化疗后病理完全缓解（pCR）的三阴性乳腺癌（TNBC）患者可能适合非手术治疗。本研究的目的是确定与残留疾病相关的基线临床病理变量，并评估新辅助化疗对 TNBC 中浸润性和导管原位癌（DCIS）成分的影响。
确定接受新辅助化疗后行手术切除的 TNBC 患者。将 pCR 患者与乳房和/或淋巴结残留疾病患者进行比较。分析临床病理变量，以确定其与残留疾病的相关性。
在 328 例患者中，36.9%无残留疾病，9.1%仅有 DCIS 残留。有残留疾病的患者更可能有恶性微钙化（P=0.023）和初始核心针活检（CNB）上的 DCIS（P=0.030）。与残留疾病独立相关的变量包括：CNB 上的 DCIS（比值比（OR）2.46；P=0.022）、T2 疾病（OR 2.40；P=0.029）、N1 状态（OR 2.03；P=0.030）和低 Ki-67（OR 2.41；P=0.083）。新辅助化疗后的影像学检查对乳房和淋巴结残留疾病的准确性为 71.7%（95%置信区间 66.3%至 76.6%），阴性预测值为 76.9%（60.7%至 88.9%）。新辅助化疗未能消除 55%患者的 DCIS 成分。
影像学上存在微钙化和初始 CNB 上的 DCIS 与 TNBC 新辅助化疗后的残留疾病相关。这些变量可以帮助识别适合纳入新辅助化疗后非手术治疗临床试验的 TNBC 患者。
