Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center, and Research Institute, Weil Cornell Medical College, Houston, TX, 77030, USA.
Breast Cancer Res Treat. 2018 Aug;170(3):559-567. doi: 10.1007/s10549-018-4801-3. Epub 2018 Apr 24.
This is the largest study to date evaluating response rates and pathologic complete response (pCR) and predictors thereof, based on molecular subtype, in women with breast cancer having undergone neoadjuvant chemotherapy (NC).
The National Cancer Database was queried for women with cT1-4N1-3M0 breast cancer having received NC. Patients were divided into four subtypes: luminal A, luminal B, Her2, or triple negative (TN). Multivariable logistic regression ascertained factors associated with developing pCR. Kaplan-Meier analysis evaluated overall survival (OS) between patients by degree of response to NC when stratifying patients by subtype.
Of a total of 13,939 women, 322 (2%) were luminal A, 5941 (43%) luminal B, 2274 (16%) Her2, and 5402 (39%) TN. Overall, 19% of all patients achieved pCR, the lowest in luminal A (0.3%) and the highest in Her2 (38.7%). Molecular subtype was an independent predictor of both pCR and OS in this population. Clinical downstaging was associated with improved survival, mostly in women with luminal B, Her2, and TN subtypes. Subgroup analysis of the pCR population demonstrated 5-year OS in the luminal B, Her2, and TN cohorts of 93.0, 94.2, and 90.6%, respectively (Her2 vs. TN, p = 0.016).
Assessing nearly 14,000 women from a contemporary United States database, this is the largest known study examining the relationship between response to NC and molecular subtype. Women with luminal A disease are the least likely to undergo pCR, with the highest rates in Her2 disease. Degree of response is associated with OS, especially in luminal B, Her2, and TN patients. Despite the comparatively higher likelihood of achieving pCR in TN cases, this subgroup may still experience a survival detriment, which has implications for an ongoing national randomized trial.
这是迄今为止评估接受新辅助化疗（NC）的乳腺癌女性的缓解率和病理完全缓解（pCR）以及基于分子亚型的预测因素的最大研究。
国家癌症数据库查询了接受 NC 的 cT1-4N1-3M0 乳腺癌女性患者。患者分为四组： luminal A、luminal B、Her2 或三阴性（TN）。多变量逻辑回归确定与发生 pCR 相关的因素。Kaplan-Meier 分析评估了通过患者对 NC 的反应程度在亚组患者中分层时的总生存（OS）。
在总共 13939 名女性中，322 名（2%）为 luminal A、5941 名（43%）为 luminal B、2274 名（16%）为 Her2、5402 名（39%）为 TN。总体而言，所有患者中有 19%达到 pCR，luminal A 最低（0.3%），Her2 最高（38.7%）。在该人群中，分子亚型是 pCR 和 OS 的独立预测因素。临床降期与生存改善相关，主要发生在 luminal B、Her2 和 TN 亚型的女性中。pCR 人群的亚组分析显示，luminal B、Her2 和 TN 队列的 5 年 OS 分别为 93.0%、94.2%和 90.6%（Her2 与 TN，p=0.016）。
评估了来自美国当代数据库的近 14000 名女性，这是迄今为止已知的最大研究，研究了对 NC 的反应与分子亚型之间的关系。患有 luminal A 疾病的女性最不可能发生 pCR，而 Her2 疾病的发生率最高。反应程度与 OS 相关，特别是在 luminal B、Her2 和 TN 患者中。尽管 TN 病例更有可能实现 pCR，但这一组仍可能存在生存不利，这对正在进行的全国随机试验有影响。
