Blanco Sánchez Alberto, Yébenes Laura, Berjón Alberto, Hardisson David
Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España.
Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España; Laboratorio de Patología Molecular del Cáncer y Dianas Terapéuticas, Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, España.
Rev Esp Patol. 2021 Jan-Mar;54(1):8-16. doi: 10.1016/j.patol.2020.07.003. Epub 2020 Aug 28.
Breast cancer can be classified into different molecular subtypes with important therapeutic and prognostic implications. Neoadjuvant chemotherapy (NAC) increases the possibility of performing conservative surgery and allows in vivo testing of the sensitivity of the tumor. Our aim was to evaluate the pathological response to NAC in relation to the molecular phenotype and the different definitions of the pathological response.
228 patients treated with NAC and subsequent surgery between 2012 and 2018 were selected from our breast cancer database. Molecular phenotypes were established based on the criteria of the St Gallen 2013 Conference. Pathological response was evaluated following Miller-Payne (breast) and Sataloff (axilla) classification systems.
The most frequent molecular phenotype was luminal B/HER2 negative (30.3%), followed by luminal B/HER2 positive (26.3%), triple negative (24.6%), HER2 positive (13.2%), and luminal A (5.7%). The rate of pathological complete response (pCR) was 35.5% in breast and 15.3% in axilla. The rate of pCR considering breast and axilla together was 26.8%. The molecular phenotype with the highest rate of pCR was HER2 positive (66.7%) followed by triple negative (30.4%), luminal B/HER2 positive (21.7%), luminal B/HER2 negative (14.5%), and luminal A (7.7%) (p < 0.001). The same results were found with the different definitions of pCR we evaluated.
Complete pathological response to NAC in breast cancer depends largely on the molecular phenotype of the tumor, regardless of the definition of pCR, with the highest response rates in the breast and axilla in the HER2 positive and triple negative phenotypes.
乳腺癌可分为不同的分子亚型，具有重要的治疗和预后意义。新辅助化疗（NAC）增加了进行保乳手术的可能性，并能在体内检测肿瘤的敏感性。我们的目的是评估NAC的病理反应与分子表型及病理反应的不同定义之间的关系。
从我们的乳腺癌数据库中选取了2012年至2018年间接受NAC及后续手术治疗的228例患者。根据2013年圣加仑会议的标准确定分子表型。按照米勒-佩恩（乳腺）和萨塔洛夫（腋窝）分类系统评估病理反应。
最常见的分子表型是管腔B/HER2阴性（30.3%），其次是管腔B/HER2阳性（26.3%）、三阴性（24.6%）、HER2阳性（13.2%）和管腔A（5.7%）。乳腺的病理完全缓解（pCR）率为35.5%，腋窝为15.3%。乳腺和腋窝一起考虑的pCR率为26.8%。pCR率最高的分子表型是HER2阳性（66.7%），其次是三阴性（30.4%）、管腔B/HER2阳性（21.7%）、管腔B/HER2阴性（14.5%）和管腔A（7.7%）（p<0.001）。我们评估的不同pCR定义也得出了相同的结果。
乳腺癌对NAC的完全病理反应在很大程度上取决于肿瘤的分子表型，无论pCR的定义如何，HER2阳性和三阴性表型在乳腺和腋窝中的反应率最高。
