Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Clinic of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
Acta Oncol. 2020 Sep;59(9):1036-1042. doi: 10.1080/0284186X.2020.1760350. Epub 2020 May 12.
In Finland, breast cancers treated with neoadjuvant chemotherapy (NACT) are usually locally advanced and/or have an inflammatory phenotype. We evaluated early NACT responses in breast tumours and lymph nodes and their correlation with survival. We collected a retrospective dataset of 145 patients with very high-risk but non-metastasised breast cancers that were treated with NACT in a Finnish University Hospital between September 2013 and January 2019. The patients underwent magnetic resonance imaging (MRI) scans before beginning NACT and after every second NACT cycle thereafter. The total pathological complete response rate was only 10.7% and breast cancer-specific survival (BCSS) at 24 months was 93.0%. The 2-year breast cancer-specific survival (BCSS) rate was 93.0%, but this varied from 86.5% for the triple-negative subtype to 100.0% for the luminal A-like subtype. Enlargement of the malignant axillary lymph nodes during the first two NACT cycles was associated with poor BCSS rates in HER2-negative patients ( = .00003 in the univariate analysis; hazard ratio = 26.3; 95% confidence interval = 2.66-259.6; = .005 in the multivariate analysis). Furthermore, progression in the combined diameters of the breast tumours and axillary lymph nodes during the period between a patient's pre-treatment MRI and her MRI after two NACT cycles was also correlated with worse BCSS rates in both univariate and multivariate analyses. An early MRI assessment after two NACT cycles, specifically of the tumour's axillary lymph nodes, has the potential to predict short-term BCSS in patients with locally advanced HER2-negative breast cancers.
在芬兰，接受新辅助化疗（NACT）的乳腺癌通常为局部晚期和/或具有炎症表型。我们评估了乳腺癌和淋巴结的早期 NACT 反应及其与生存的相关性。我们收集了 2013 年 9 月至 2019 年 1 月期间在芬兰一家大学医院接受 NACT 治疗的 145 例高危但无转移的乳腺癌患者的回顾性数据集。患者在开始 NACT 前和此后的每两个 NACT 周期后接受磁共振成像（MRI）扫描。总病理完全缓解率仅为 10.7%，24 个月时乳腺癌特异性生存率（BCSS）为 93.0%。2 年 BCSS 率为 93.0%，但三阴性亚型为 86.5%， luminal A 样亚型为 100.0%。在 NACT 的前两个周期中，恶性腋窝淋巴结的增大与 HER2 阴性患者的 BCSS 率较低相关（单因素分析中，= 0.00003；危险比= 26.3；95%置信区间= 2.66-259.6；多因素分析中，= 0.005）。此外，在患者治疗前 MRI 和接受两个 NACT 周期后的 MRI 之间，乳房肿瘤和腋窝淋巴结的联合直径的进展与单因素和多因素分析中的较差 BCSS 率相关。在接受两个 NACT 周期后，特别是对肿瘤腋窝淋巴结进行早期 MRI 评估，有可能预测局部晚期 HER2 阴性乳腺癌患者的短期 BCSS。
