Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Surg Today. 2020 Feb;50(2):178-184. doi: 10.1007/s00595-019-01858-x. Epub 2019 Jul 31.
The present study aimed to identify the predictive factors of an axillary pathological complete response (Ax-pCR) in patients with node-positive breast cancer who underwent neoadjuvant chemotherapy (NAC).
The present study included 219 patients who underwent NAC followed by curative surgery, including axillary lymph node dissection (ALND), for 221 breast cancers between January 2010 and April 2018. All patients were clinically and/or pathologically confirmed to be node-positive at the initial diagnosis. The predictive factors of Ax-pCR were analyzed using a chi-square test and multivariate logistic regression models.
Ninety-five patients (43%) achieved Ax-pCR after NAC. The odds of achieving Ax-pCR were significantly improved when tumors were high grade (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.00-4.84), estrogen receptor (ER) negative (OR 2.65 95% CI 1.23-5.70), ycN0 on ultrasound (US) imaging (OR 3.89, 95% CI 1.90-7.97), and showed a clinical complete response (CR) at the primary site after NAC (OR 4.22, 95% CI 1.59-11.27).
Ax-pCR was more likely to be achieved in patients who were diagnosed with ER-negative and high-grade breast cancer and those with ycN0 and clinical CR at the primary site after NAC than among others. Among these patients, those with initially cN1/N2 might be good candidates for a deescalated treatment strategy after NAC.
本研究旨在确定接受新辅助化疗（NAC）的淋巴结阳性乳腺癌患者腋窝病理完全缓解（Ax-pCR）的预测因素。
本研究纳入了 2010 年 1 月至 2018 年 4 月期间 219 例接受 NAC 联合根治性手术（包括腋窝淋巴结清扫术）治疗的 221 例乳腺癌患者。所有患者在初始诊断时均经临床和/或病理证实为淋巴结阳性。采用卡方检验和多因素 logistic 回归模型分析 Ax-pCR 的预测因素。
95 例（43%）患者在 NAC 后达到 Ax-pCR。肿瘤分级高（比值比 [OR] 2.20，95%置信区间 [CI] 1.00-4.84）、雌激素受体（ER）阴性（OR 2.65，95%CI 1.23-5.70）、超声（US）检查中 ycN0（OR 3.89，95%CI 1.90-7.97）以及 NAC 后原发部位出现临床完全缓解（CR）（OR 4.22，95%CI 1.59-11.27）时，Ax-pCR 的可能性显著增加。
与其他患者相比，诊断为 ER 阴性和高级别乳腺癌、ycN0 和 NAC 后原发部位出现临床 CR 的患者更有可能达到 Ax-pCR。对于这些患者，那些初始 cN1/N2 的患者可能是 NAC 后降级治疗策略的良好候选者。
