Wang Yu, Li Longfei, Liu Xiyao, Wang Yihua, Tang Zhenrong, Wu Yinan, Jin Yudi, Liu Shengchun
Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
School of Public Health and Management, Chongqing Medical University, Chongqing, China.
Gland Surg. 2021 Feb;10(2):656-669. doi: 10.21037/gs-20-686.
Excellent response of the primary tumor after neoadjuvant therapy may indicate a better axillary status in breast cancer. However, this treatment response correlation has not been investigated in Chinese breast cancer patients.
Patients diagnosed with breast cancer and treated with neoadjuvant therapy were included in this retrospective study, conducted at a comprehensive breast cancer institution in China. Clinicopathological factors at baseline were analyzed by univariate and multivariate analyses. Furthermore, association rules analyses were used to investigate the correlation between the pathologic response of the primary tumor and that of the axillary lymph nodes based on such factors.
Multivariate logistic regression analysis showed that breast pathologic response was influenced by tumor size, classification of regional lymph nodes, histological grade, progesterone receptor status, and Ki67 expression. The potential influencing factor for the pathologic response of the axilla was found to be regional lymph node classification. The findings from association rules analyses demonstrated that when a pathologic complete response (pCR) in the breast was achieved among patients with cTN and hormone receptor-negative disease, the axilla response in these patients was also highly likely to be pCR (the likelihood for axilla pCR was more than 90%). However, cTN patients hardly achieved pCR for both the primary tumor and axillary lymph nodes (mean confidence, 0.9637). The clinicopathological factors accounting for the inconsistent response between the breast and the axilla were found to be hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, and low Ki67 expression.
Our findings suggest a strong correlation between breast pCR and axilla pCR among patients with specific characteristics. These findings provide a basis for the selection of candidates for clinical trials on the omission of axillary surgery.
新辅助治疗后原发肿瘤的良好反应可能表明乳腺癌患者腋窝状态较好。然而，尚未在中国乳腺癌患者中研究这种治疗反应的相关性。
本回顾性研究纳入了在中国一家综合性乳腺癌机构诊断为乳腺癌并接受新辅助治疗的患者。通过单因素和多因素分析对基线时的临床病理因素进行分析。此外，基于这些因素，采用关联规则分析研究原发肿瘤与腋窝淋巴结病理反应之间的相关性。
多因素逻辑回归分析显示，乳腺病理反应受肿瘤大小、区域淋巴结分类、组织学分级、孕激素受体状态和Ki67表达影响。发现腋窝病理反应的潜在影响因素是区域淋巴结分类。关联规则分析的结果表明，在cTN和激素受体阴性疾病患者中，当乳腺达到病理完全缓解（pCR）时，这些患者的腋窝反应也极有可能为pCR（腋窝pCR的可能性超过90%）。然而，cTN患者的原发肿瘤和腋窝淋巴结几乎都未达到pCR（平均置信度为0.9637）。发现乳腺与腋窝反应不一致的临床病理因素为激素受体阳性、人表皮生长因子受体2（HER2）阴性和Ki67低表达。
我们的研究结果表明，具有特定特征的患者中乳腺pCR与腋窝pCR之间存在很强的相关性。这些发现为选择省略腋窝手术的临床试验候选者提供了依据。
