Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsfrauenklinik Mannheim, Germany.
Breast Center, University Hospital Frankfurt, Germany.
Eur J Cancer. 2021 Aug;153:203-212. doi: 10.1016/j.ejca.2021.05.027. Epub 2021 Jun 26.
Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with superior survival. This association is strongest in triple-negative breast cancer (TNBC). The CPS + EG system, based on pre-treatment clinical (CS) and post-treatment pathological stage (PS), oestrogen-receptor status (E) and grade (G), leads to a refined estimate of prognosis after NACT in all-comers and hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Here, we investigate if CPS + EG scoring provides a superior estimate of prognosis in TNBC to select patients for postneoadjuvant therapy.
We calculated the CPS + EG score for 1795 patients with TNBC from 8 prospective German trials. Five-year disease-free survival (DFS) and overall survival estimates were calculated using the Kaplan-Meier method.
In TNBC, patients with pCR (ypT0/is ypN0, n = 822, 45.8%) had a 5-year DFS of 86%, whereas patients with residual American Joint Committee on Cancer stage I disease (n = 383; 21.3%) had a 5-year DFS of 77.5%.CPS + EG led to superior prognostic information compared with that provided by the clinical stage, but it was inferior to the prognostic information provided by the pathological stage (c-index statistics, p < 0.001). CPS + EG did not discriminate prognosis within the two best prognostic groups (score 1 and 2; n = 362; 37.2%). In contrast, pCR status added prognostic information beyond CPS + EG. Patients with a CPS + EG score of 3 had a 5-year DFS rate of 64% overall, but those with pCR had a 5-year DFS rate of 84%, and those without pCR had a 5-year DFS rate of only 49.7%.
In TNBC, CPS + EG scoring provided inferior prognostic information compared with the pathological stage and was unable to identify patients without pCR and with a sufficiently good prognosis, who could avoid postneoadjuvant therapy. pCR remains the strongest and most clinically useful prognostic factor after NACT. Other biologic factors beyond pCR are needed in TNBC.
新辅助化疗（NACT）后的病理完全缓解（pCR）与生存改善相关。这种相关性在三阴性乳腺癌（TNBC）中最强。CPS+EG 系统基于治疗前的临床（CS）和治疗后的病理分期（PS）、雌激素受体状态（E）和分级（G），可对所有入组患者和激素受体阳性/人表皮生长因子受体 2（HER2）阴性乳腺癌的 NACT 后预后进行更精确的评估。在此，我们研究 CPS+EG 评分是否能为 TNBC 患者提供更好的预后估计，以选择接受辅助治疗的患者。
我们为 8 项德国前瞻性研究中的 1795 例 TNBC 患者计算了 CPS+EG 评分。使用 Kaplan-Meier 法计算 5 年无病生存（DFS）和总生存估计值。
在 TNBC 中，pCR（ypT0/is ypN0，n=822，45.8%）患者 5 年 DFS 率为 86%，而残留美国癌症联合委员会 I 期疾病（n=383；21.3%）患者 5 年 DFS 率为 77.5%。CPS+EG 提供的预后信息优于临床分期，但劣于病理分期（c 指数统计学，p<0.001）。CPS+EG 在两个最佳预后组（评分 1 和 2；n=362；37.2%）内无法区分预后。相比之下，pCR 状态提供了 CPS+EG 之外的预后信息。CPS+EG 评分 3 的患者总 5 年 DFS 率为 64%，但 pCR 患者为 84%，无 pCR 患者为 49.7%。
在 TNBC 中，CPS+EG 评分提供的预后信息劣于病理分期，且无法识别无 pCR 且预后良好的患者，这些患者可避免接受辅助治疗。pCR 仍然是 NACT 后最强且最具临床意义的预后因素。在 TNBC 中，需要寻找 pCR 以外的其他生物学因素。
