Al-Tweigeri Taher, Elshenawy Mahmoud, Badran Ahmed, Omar Ayman, Suleman Kausar, Al Malik Osama, Anwar Ihab, Jastaniya Noha, Tulbah Asma, Al Shabanah Mohammad, Ajarim Dahish, Al Sayed Adher
Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11564, Saudi Arabia.
Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin El Kom 32511, Egypt.
J Oncol. 2021 Feb 12;2021:6639763. doi: 10.1155/2021/6639763. eCollection 2021.
This study was designed to examine the relationship between breast cancer molecular subtypes and pathological response to neoadjuvant chemotherapy (NAC) ± trastuzumab, in locally advanced breast cancer (LABC).
Female patients with LABC (T2-T4, N0-N2, and M0) who received neoadjuvant chemotherapy + trastuzumab if HER2+ subtype, followed by surgery and radiotherapy ± hormonal therapy, were identified. The primary endpoint was pathologic complete response (pCR) in the breast and axilla (ypT0/ypN0), with final analysis on disease-free survival (DFS) and overall survival (OS).
Six hundred eighty-one patients with a median age of 44 years, premenopausal: 70%, median tumour size: 7.0 cm (range 4-11 cm), stage II B: 27% and III A/III B: 73%, ER+/HER2-: 40.8%, ER-/HER2-: 23%, ER+/HER2+: 17.7%, and ER-/HER2+: 18.5%. Overall pCR (ypT0/ypN0) was 23%. The pCR rates based on molecular subtypes were ER+/HER2-: 9%; ER+/HER2+: 29%; ER-/HER2-: 31%; and ER-/HER2+: 37%. At median follow-up of 61 months, ER+/HER2+ and ER+/HER2- subtypes had the best 5-year DFS and OS; meanwhile, ER-/HER2+ and ER-/HER2- subtypes had the worst.
Women with ER+/HER2- disease are the least likely to achieve pCR, with the highest rates in HER2+ and triple-negative subgroups. Degree of response is associated with OS; despite the comparatively higher likelihood of achieving pCR in ER-/HER2+ and triple-negative, these subgroups experience a survival detriment. We are consistent with the published data that patients who attain the pathological complete response defined as ypT0/ypN0 have improved outcomes.
本研究旨在探讨局部晚期乳腺癌（LABC）中乳腺癌分子亚型与新辅助化疗（NAC）±曲妥珠单抗病理反应之间的关系。
纳入接受新辅助化疗的LABC女性患者（T2-T4，N0-N2，M0），HER2+亚型患者加用曲妥珠单抗，随后接受手术及放疗±激素治疗。主要终点为乳腺和腋窝的病理完全缓解（pCR，ypT0/ypN0），并对无病生存期（DFS）和总生存期（OS）进行最终分析。
681例患者，中位年龄44岁，绝经前：70%，中位肿瘤大小：7.0 cm（范围4-11 cm），II B期：27%，III A/III B期：73%，ER+/HER2-：40.8%，ER-/HER2-：23%，ER+/HER2+：17.7%，ER-/HER2+：18.5%。总体pCR（ypT0/ypN0）为23%。基于分子亚型的pCR率分别为：ER+/HER2-：9%；ER+/HER2+：29%；ER-/HER2-：31%；ER-/HER2+：37%。中位随访61个月时，ER+/HER2+和ER+/HER2-亚型的5年DFS和OS最佳；同时，ER-/HER2+和ER-/HER2-亚型最差。
ER+/HER2-疾病的女性患者达到pCR的可能性最小，HER2+和三阴性亚组的pCR率最高。反应程度与OS相关；尽管ER-/HER2+和三阴性亚组达到pCR的可能性相对较高，但这些亚组的生存期较差。我们与已发表的数据一致，即达到ypT0/ypN0定义的病理完全缓解的患者预后改善。
