Department of Pathology, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India.
Department of Medical Oncology, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India.
J Cancer Res Ther. 2020 Oct-Dec;16(6):1419-1425. doi: 10.4103/jcrt.JCRT_295_19.
Neoadjuvant chemotherapy (NACT) has become a strategy in the multidisciplinary treatment approach to breast cancer. Since clinical and radiological responses do not correlate well with residual tumor after treatment, pathological evaluation of tumor response to chemotherapy is essential for accurate assessment.
The aim of this study is to assess clinicopathological response to NACT in patients with invasive breast carcinoma.
Single institution, retrospective study was conducted for 4 years.
The study included 95 cases with the clinical diagnosis of locally advanced breast cancer and invasive breast carcinoma on histopathological examination of core needle biopsy/lumpectomy specimen. These cases were assessed for estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) receptors and treated with four cycles of NACT (adriamycin-cyclophosphamide) therapy. Histopathological examination of postchemo modified radical mastectomy specimens was performed following standard protocol. The pathological response of tumor to chemotherapy was assessed on Miller-Payne grading (MPG) and residual disease in breast and lymph node (RDBN) level.
Data were analyzed in percentages and presented in charts and tables.
Histopathological examination of pre-chemo biopsy specimens revealed invasive ductal carcinoma No special type (NST) in maximum, 89 (93.7%) cases. Majority 43 (45.3%) cases were HER2-positive followed by estrogen receptor-positive and/or progesterone receptor positive and HER2-positive type seen in 23 (24.2%) cases and 22 (23.1%) cases were triple negative. Sixteen (16.8%) and 76 (80%) cases showed pathological complete response (pCR) and partial pathological response, respectively, to NACT on MPG; 12 (12.6%) and 83 (87.4%) cases showed pCR and residual disease, respectively, on RDBN level. Majority 37.5% and 50% of cases showing pCR on MPG and RDBN level, respectively, were triple negative.
This study highlights the clinicopathological response to NACT in carcinoma breast patients and identifies the molecular subtypes of these patients likely to respond to NACT.
新辅助化疗（NACT）已成为乳腺癌多学科治疗方法的一种策略。由于临床和影像学反应与治疗后残留肿瘤相关性不佳，因此对化疗的肿瘤反应进行病理评估对于准确评估至关重要。
本研究旨在评估新辅助化疗对浸润性乳腺癌患者的临床病理反应。
进行了一项为期 4 年的单机构回顾性研究。
该研究纳入了 95 例临床诊断为局部晚期乳腺癌和浸润性乳腺癌的患者，这些患者的核心针活检/肿块切除术标本经组织病理学检查确诊。这些患者接受了 4 个周期的 NACT（阿霉素-环磷酰胺）治疗，并评估了雌激素、孕激素和人表皮生长因子受体 2（HER2）受体。按照标准方案对化疗后改良根治性乳房切除术标本进行组织病理学检查。根据 Miller-Payne 分级（MPG）和乳腺和淋巴结残留疾病（RDBN）水平评估肿瘤对化疗的病理反应。
数据以百分比表示，并以图表和表格形式呈现。
术前活检标本的组织病理学检查显示，最大程度为非特殊型浸润性导管癌 89 例（93.7%）。43 例（45.3%）患者为 HER2 阳性，其次是雌激素受体阳性和/或孕激素受体阳性且 HER2 阳性的患者，分别为 23 例（24.2%）和 22 例（23.1%）；三阴性患者为 16 例（16.8%）和 76 例（80%）分别显示出 MPG 上的完全病理缓解（pCR）和部分病理缓解；12 例（12.6%）和 83 例（87.4%）分别显示 RDBN 水平上的 pCR 和残留疾病。MPG 和 RDBN 水平上分别有 37.5%和 50%的 pCR 患者为三阴性。
本研究强调了乳腺癌患者对 NACT 的临床病理反应，并确定了这些患者对 NACT 可能有反应的分子亚型。
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