Department of Surgery, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Department of Pathology, Centre René Huguenin- Institut Curie, 35 Rue Dailly, 92210 St Cloud, France.
Breast. 2018 Dec;42:61-67. doi: 10.1016/j.breast.2018.08.103. Epub 2018 Aug 28.
Pregnancy-associated breast cancer (PABC) refers to breast cancers (BC) diagnosed during pregnancy or shortly after birth. Although the inflammatory environment of post-partum PABC cases (designed as PP-PABC) may be deleterious, so far PP-PABC have scarcely been distinguished from breast cancers diagnosed during pregnancy. Furthermore, whether PP-PABC cases have an enhanced immune infiltration remains unknown. We investigated chemosensitivity, immune infiltration and survival of PP-PABC patients treated by neoadjuvant chemotherapy (NAC) compared to non-PABC matched BC patients.
We identified PP-PABC cases among a cohort of 1199 invasive BC treated with NAC between 2002 and 2012. Each PP-PABC case was matched with 3 non-PABC controls, according to age and pathological breast cancer subtype. Microbiopsy specimens and paired surgical samples were evaluated for stromal lymphocyte infiltration. Association of clinical and pathological factors with pathological complete response (pCR) and disease-free survival (DFS) was assessed by univariate and multivariate analyses.
Our final population study was composed of 116 patients (29 PP-PABC and 87 non-PABC). Median follow-up was of 49.0 and 29.3 months, respectively. After NAC, pCR rates (p = 0.64), post-NAC immune infiltration (stromal TILs: p = 0.67; intratumoral TILs: p = 0.14), and DFS rates (p = 0.17) were comparable between PP-PABC and non-PABC patients in global population. Similar results were found after stratification by pathological subtype.
We observed similar patterns between postpartum PABC and control tumors in terms of chemosensitivity, immune infiltration, and prognostic. Our results enhance the idea that PP-PABC should receive the same standard of care treatment as other patients, including neoadjuvant chemotherapy.
妊娠相关性乳腺癌（PABC）是指在妊娠期间或产后不久诊断出的乳腺癌（BC）。尽管产后 PABC 病例的炎症环境可能有害（设计为 PP-PABC），但迄今为止，PP-PABC 与妊娠期间诊断出的乳腺癌几乎没有区别。此外，PP-PABC 病例是否具有增强的免疫浸润仍不清楚。我们研究了接受新辅助化疗（NAC）治疗的 PP-PABC 患者与非 PABC 匹配的 BC 患者相比的化疗敏感性、免疫浸润和生存情况。
我们在 2002 年至 2012 年间接受 NAC 治疗的 1199 例浸润性 BC 队列中确定了 PP-PABC 病例。根据年龄和病理乳腺癌亚型，每个 PP-PABC 病例与 3 个非 PABC 对照匹配。对微活检标本和配对手术标本进行间质淋巴细胞浸润评估。通过单变量和多变量分析评估临床和病理因素与病理完全缓解（pCR）和无病生存（DFS）的相关性。
我们的最终人群研究由 116 名患者（29 例 PP-PABC 和 87 例非 PABC）组成。中位随访时间分别为 49.0 和 29.3 个月。在 NAC 后，pCR 率（p=0.64）、NAC 后免疫浸润（间质 TILs：p=0.67；肿瘤内 TILs：p=0.14）和 DFS 率（p=0.17）在总体人群中，PP-PABC 和非 PABC 患者之间无差异。按病理亚型分层后也得到了类似的结果。
我们观察到产后 PABC 与对照肿瘤在化疗敏感性、免疫浸润和预后方面具有相似的模式。我们的结果增强了这样一种观点，即 PP-PABC 应接受与其他患者相同的标准治疗，包括新辅助化疗。
