Ouldamer Lobna, Chas Marie, Arbion Flavie, Body Gilles, Cirier Julien, Ballester Marcos, Bendifallah Sofiane, Daraï Emile
Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France.
Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.
Surg Oncol. 2018 Jun;27(2):158-165. doi: 10.1016/j.suronc.2018.02.003. Epub 2018 Feb 21.
One of the current therapeutic challenges for women with breast cancer receiving neoadjuvant chemotherapy (NAC) is distinguishing women with complete axillary nodal response from those with axillary residual disease to promote a personalized therapeutic strategy including sparing axillary surgery. This study set out to develop a risk scoring system (RSS) for predicting probability of nodal pathological complete response (pCR) in women presenting with cN1 breast cancer who received NAC.
Data of 116 women with cN1 breast cancer who received NAC between January 2009 and December 2013 were abstracted from our prospectively maintained database. A risk model based on factors impacting nodal axillary was developed.
The overall nodal conversion rate was 36.2% (42/116). Axillary nodal response was associated with three variables: menopausal status [Odds ratio (OR) = 0.23; 95% confidence interval (CI) 0.09-0.60], the radiological % of breast tumour shrinkage ≥50% (OR = 3.71; 95% CI 1.51-9.10), and negative hormone receptors (ER-, PR-) (OR = 2.41; 95% CI 0.99-5.87). These variables were included in the RSS and assigned scores ranging from 0 to 2. The discrimination of the RSS was 0.78 [95% confidence interval (CI) 0.69-0.86]. A total score of 3 points corresponded to the optimal threshold of the RSS. The diagnostic accuracy was 74.1%.
This study shows that the probability of axillary nodal pCR after NAC can be accurately predicted so that women at high probability may be spared of axillary surgery.
对于接受新辅助化疗（NAC）的乳腺癌女性患者而言，当前的治疗挑战之一是区分腋窝淋巴结完全缓解的女性与有腋窝残留病灶的女性，以推动包括避免腋窝手术在内的个性化治疗策略。本研究旨在开发一种风险评分系统（RSS），用于预测接受NAC的cN1期乳腺癌女性患者出现淋巴结病理完全缓解（pCR）的概率。
从我们前瞻性维护的数据库中提取了2009年1月至2013年12月期间接受NAC的116例cN1期乳腺癌女性患者的数据。基于影响腋窝淋巴结的因素开发了一种风险模型。
总体淋巴结转化率为36.2%（42/116）。腋窝淋巴结反应与三个变量相关：绝经状态[比值比（OR）=0.23；95%置信区间（CI）0.09 - 0.60]、乳腺肿瘤缩小≥50%的放射学比例（OR = 3.71；95% CI 1.51 - 9.10）以及激素受体阴性（ER-、PR-）（OR = 2.41；95% CI 0.99 - 5.87）。这些变量被纳入RSS并赋予0至2分的分数。RSS的辨别力为0.78[95%置信区间（CI）0.69 - 0.86]。总分为3分对应于RSS的最佳阈值。诊断准确性为74.1%。
本研究表明，NAC后腋窝淋巴结pCR的概率可以准确预测，因此高概率患者可能无需进行腋窝手术。
