Boland M R, McVeigh T P, O'Flaherty N, Gullo G, Keane M, Quinn C M, McDermott E W, Lowery A J, Kerin M J, Prichard R S
Department of Breast Surgery St Vincent's University Hospital Dublin Ireland.
Department of Breast Surgery University College Hospital Galway Galway Ireland.
BJS Open. 2017 Jul 31;1(2):39-45. doi: 10.1002/bjs5.6. eCollection 2017 Apr.
Optimal evaluation and management of the axilla following neoadjuvant chemotherapy (NAC) in patients with node-positive breast cancer remains controversial. The aim of this study was to examine the impact of receptor phenotype in patients with nodal metastases who undergo NAC to see whether this approach can identify those who may be suitable for conservative axillary management.
Between 2009 and 2014, all patients with breast cancer and biopsy-proven nodal disease who received NAC were identified from prospectively developed databases. Details of patients who had axillary lymph node dissection (ALND) following NAC were recorded and rates of pathological complete response (pCR) were evaluated for receptor phenotype.
Some 284 patients with primary breast cancer and nodal metastases underwent NAC and subsequent ALND, including two with bilateral disease. The most common receptor phenotype was luminal A (154 of 286 tumours, 53·8 per cent), with lesser proportions accounted for by the luminal B-Her2 type (64, 22·4 per cent), Her2-overexpressing (38, 13·3 per cent) and basal-like, triple-negative (30, 10·5 per cent) subtypes. Overall pCR rates in the breast and axilla were 19·9 per cent (54 of 271 tumours) and 37·4 per cent (105 of 281) respectively. Axillary pCR rates were highest in the Her2-overexpressing group (27 of 35, 77 per cent) and lowest in the luminal A group (35 of 153, 22·9 per cent) (P < 0·001). Nodal burden (median number of positive nodes excised) was lower in the Her2-overexpressing group compared with the luminal A group (0 versus 3; P < 0·001).
Her2 positivity was associated with increased rates of axillary pCR and reduced nodal burden following NAC.
对于淋巴结阳性乳腺癌患者，新辅助化疗（NAC）后腋窝的最佳评估和处理仍存在争议。本研究的目的是探讨受体表型对接受NAC的有淋巴结转移患者的影响，以确定这种方法是否能识别出可能适合腋窝保守处理的患者。
2009年至2014年期间，从前瞻性建立的数据库中识别出所有经活检证实有淋巴结疾病且接受NAC的乳腺癌患者。记录NAC后接受腋窝淋巴结清扫（ALND）患者的详细情况，并评估受体表型的病理完全缓解（pCR）率。
约284例原发性乳腺癌伴淋巴结转移患者接受了NAC及随后的ALND，其中2例为双侧病变。最常见的受体表型是腔面A型（286例肿瘤中的154例，53.8%），腔面B-Her2型（64例，22.4%）、Her2过表达型（38例，13.3%）和基底样三阴性型（30例，10.5%）亚型所占比例较小。乳腺和腋窝的总体pCR率分别为19.9%（271例肿瘤中的54例）和37.4%（281例中的105例）。腋窝pCR率在Her2过表达组最高（35例中的27例，77%），在腔面A型组最低（153例中的35例，22.9%）（P<0.001）。与腔面A型组相比，Her2过表达组的淋巴结负荷（切除的阳性淋巴结中位数）更低（0对3；P<0.001）。
Her2阳性与NAC后腋窝pCR率增加及淋巴结负荷降低相关。
