CPS+EG 评分系统在新辅助化疗治疗三阴性乳腺癌中的应用。
Utility of the CPS + EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy.
机构信息
Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsfrauenklinik Mannheim, Germany.
Breast Center, University Hospital Frankfurt, Germany.
出版信息
Eur J Cancer. 2021 Aug;153:203-212. doi: 10.1016/j.ejca.2021.05.027. Epub 2021 Jun 26.
BACKGROUND
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.
METHODS
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.
RESULTS
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%.
CONCLUSIONS
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.
背景
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。
方法
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。
结果
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%。
结论
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。
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