新辅助化疗后主要乳腺癌亚型的临床结局：对乳腺癌复发和生存的影响。
Clinical Outcomes Among Major Breast Cancer Subtypes After Neoadjuvant Chemotherapy: Impact on Breast Cancer Recurrence and Survival.
机构信息
Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy;
Department of Breast Surgery, Campus Bio-Medico University, Rome, Italy.
出版信息
Anticancer Res. 2021 May;41(5):2697-2709. doi: 10.21873/anticanres.15051.
BACKGROUND/AIM: Prior studies have underlined the prognostic relevance of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer. However, an accurate demonstration of treatment efficacy is dependent on its potential to predict long-term outcomes of recurrence and death, and this issue remains somewhat controversial.
PATIENTS AND METHODS
One hundred and sixty-nine patients with breast cancer (BC) treated with NAC followed by surgery were enrolled in this retrospective study. After carrying out multivariable analyses, involving baseline characteristics (tumor stage, nodal status, histological grade, biological profile) and response status, we analysed the association between pCR and disease-free (DFS) and overall survival (OS) in various subtypes. Moreover, we investigated several residual disease-scoring combinations to check whether they could discriminate prognostic subsets according to their variable tumor range after NAC.
RESULTS
Overall, factors associated with pCR were non-luminal subtype (p<0.001), high grade (p=0.001) and HER2-overexpression (p=0.001). Residual tumor and nodal stage after NAC significantly correlated with DFS (p=0.007) and OS (p<0.001). Similarly, pCR after NAC showed significantly better DFS (p=0.01), particularly for HER2-positive (p=0.003), triple-negative (p=0.019) and HER2-positive Luminal B profiles (p=0.019). However, there was no statistical difference in the OS among patients who had PCR, compared to absence of pCR (p=0.40).
CONCLUSION
Extent of residual disease and evidence of regression provide helpful prognostic details in BC patients treated with NAC. Achieving pCR after NAC is related with significantly better DFS, with the potential of maximized breast and axillary conservation based on clinical response. The distribution of expertise in a cross-disciplinary setting could provide safe and favourable prognosis, while improving cosmetic outcomes and quality of life.
背景/目的：先前的研究强调了新辅助化疗（NAC）后病理完全缓解（pCR）对乳腺癌的预后相关性。然而，治疗效果的准确展示取决于其预测复发和死亡的长期结果的潜力，而这个问题仍然存在一些争议。
患者和方法
本回顾性研究纳入了 169 名接受 NAC 治疗后行手术的乳腺癌（BC）患者。在进行多变量分析，包括基线特征（肿瘤分期、淋巴结状态、组织学分级、生物学特征）和反应状态后，我们分析了 pCR 与无病生存（DFS）和总生存（OS）在各种亚型之间的关系。此外，我们还研究了几种残留疾病评分组合，以检查它们是否可以根据 NAC 后肿瘤范围的变化来区分预后亚组。
结果
总体而言，与 pCR 相关的因素是非 luminal 亚型（p<0.001）、高级别（p=0.001）和 HER2 过表达（p=0.001）。NAC 后残留肿瘤和淋巴结分期与 DFS（p=0.007）和 OS（p<0.001）显著相关。同样，NAC 后 pCR 显示出显著更好的 DFS（p=0.01），特别是对于 HER2 阳性（p=0.003）、三阴性（p=0.019）和 HER2 阳性 Luminal B 型（p=0.019）。然而，与无 pCR 相比，pCR 患者的 OS 无统计学差异（p=0.40）。
结论
在接受 NAC 治疗的 BC 患者中，残留疾病的程度和消退的证据提供了有帮助的预后细节。NAC 后获得 pCR 与显著更好的 DFS 相关，基于临床反应，有可能最大限度地保留乳房和腋窝。跨学科专业知识的分布可以提供安全有利的预后，同时改善美容效果和生活质量。
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