Candás Gabriela, García Alejandra, Ocampo María Delfina, Korbenfeld Ernesto, Vuoto H Daniel, Isetta Juan, Cogorno Lucas, Zimmermann Agustina González, Sigal Marca, Acevedo Santiago, Berwart Julia, Naveira Martín, Bemi Agustina, Uriburu Juan Luis
Breast Care Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina.
Oncology Service, Buenos Aires British Hospital, Buenos Aires C1280AEB, Argentina.
Ecancermedicalscience. 2021 Jan 5;15:1162. doi: 10.3332/ecancer.2021.1162. eCollection 2021.
Currently, the indication for neoadjuvant chemotherapy is increasing in the treatment of breast cancer. Variability in the expression of biomarkers following neoadjuvant treatment has been observed, which could be accompanied by changes in the adjuvant treatment.
The primary objective was to evaluate the variability of biomarkers prior to and following neoadjuvant therapy. Secondary objectives were to determine which tumour subtype (as determined by immunohistochemical markers) most frequently achieved pathological complete response (pCR); whether the biomarker variation resulted in a change in immunophenotype and subsequently modification to the adjuvant treatment.
A retrospective observational analysis was carried out on patients with a diagnosis of breast cancer who had neoadjuvant therapy prior to surgery in the Breast Care Service of the Buenos Aires British Hospital between January 2009 and June 2020.
One hundred and seventy-two patients were included. The pCR rate was 28.5%. The tumour immunophenotype that achieved pCR most frequently was the hormone receptor negative /HER2+ group with a value of 85.2%. The analysis was carried out on the 123 patients with residual disease. The observed variability for oestrogen receptors (ER) was 8.9%, for progesterone receptors (PR), 29.9% and for HER2, 13.8%. These changes were statistically significant. There were changes to the tumour immunophenotype in 26 cases (21.1%) with modifications to the adjuvant treatment in nine of these (34.6%; 7.3% of all tumours with residual disease).
In this study, we observed statistically significant variability in the expression of ER, PR and HER2 prior to and following neoadjuvant treatment, which identified modifications in the tumour immunophenotype in 21.1%, and changes to the adjuvant treatment in 7.3% of all tumours with residual disease, justifying the re-assay of biomarkers in the surgical specimen.
目前，新辅助化疗在乳腺癌治疗中的应用指征正在增加。新辅助治疗后生物标志物表达存在变异性，这可能伴随着辅助治疗的改变。
主要目的是评估新辅助治疗前后生物标志物的变异性。次要目的是确定哪种肿瘤亚型（由免疫组化标志物确定）最常达到病理完全缓解（pCR）；生物标志物的变化是否导致免疫表型改变，进而改变辅助治疗。
对2009年1月至2020年6月在布宜诺斯艾利斯英国医院乳腺护理服务中心接受手术前新辅助治疗的乳腺癌患者进行回顾性观察分析。
共纳入172例患者。pCR率为28.5%。最常达到pCR的肿瘤免疫表型是激素受体阴性/HER2+组，比例为85.2%。对123例有残留病灶的患者进行了分析。观察到雌激素受体（ER）的变异性为8.9%，孕激素受体（PR）为29.9%，HER2为13.8%。这些变化具有统计学意义。26例（21.1%）患者的肿瘤免疫表型发生改变，其中9例（34.6%；占所有有残留病灶肿瘤的7.3%）辅助治疗发生改变。
在本研究中，我们观察到新辅助治疗前后ER、PR和HER2表达存在统计学显著变异性，21.1%的患者肿瘤免疫表型发生改变，7.3%的所有有残留病灶肿瘤的辅助治疗发生改变，这证明对手术标本中的生物标志物进行重新检测是合理的。
