Chen Shin-Cheh, Yu Chi-Chang, Chang Hsien-Kun, Lin Yung-Chang, Lo Yung-Feng, Shen Shih-Che, Kuo Wen-Lin, Tsai Hsiu-Pei, Chou Hsu-Huan, Chu Chia-Hui, Shen Wen-Chi, Wu Ren-Chin, Ueng Shir-Hwa, Huang Yi-Ting
Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Cancer. 2021 Jul 6;12(17):5365-5374. doi: 10.7150/jca.62830. eCollection 2021.
Few studies have analyzed the discrepancy between breast pathologic complete response (B-pCR) and axillary node pCR (N-pCR) rates and their impact on survival outcomes in different intrinsic subtypes of early breast cancer after neoadjuvant chemotherapy (NAC). We retrospectively reviewed B-pCR, N-pCR, and total (breast and axillary node) pCR (T-pCR) after NAC to assess the discrepancy and outcomes between 2005 and 2017. A total of 968 patients diagnosed with cT1-4c, N1-2, and M0 breast cancer were enrolled in the study. The median age was 49 years and the median follow-up time was 45 months. Of these patients, 213 achieved T-pCR, 31 achieved B-pCR with axillary node pathologic non-complete response (N-non pCR), 245 achieved N-pCR with breast pathologic non-complete response (B-non pCR), and 479 achieved total (breast and axillary node) pathologic non-complete response (T-non pCR) after NAC. The highest B-pCR and N-pCR rates were found in the hormone receptor-negative, human epidermal growth factor receptor 2-positive HR(-)HER2(+) subtype, while the lowest B-pCR rate was found in the HR(+)HER2(-) subtype. The N-pCR rate was correlated to the B-pCR rate (P<0.001), but was higher than the B-pCR rate in all subtypes. The 5-year overall survival (OS) rates for patients with T-pCR, B-pCR, and N-pCR were 91.2%, 91.7%, and 91.9%, respectively. For non-pCR, non-pCR, and non-pCR, the 5-year OS rates were 73.6%, 78.9%, and 74.7%, respectively (P<0.0001). B-non pCR patients had a lower risk of recurrence than T-non pCR or N-non-pCR patients, although there were no differences in OS among them. In conclusion, the N-pCR rate was higher than the B-pCR rate after NAC in all intrinsic subtypes, and N-non pCR or T-non pCR patients had the worst outcomes.
很少有研究分析新辅助化疗（NAC）后早期乳腺癌不同内在亚型中乳腺病理完全缓解（B-pCR）和腋窝淋巴结病理完全缓解（N-pCR）率之间的差异及其对生存结果的影响。我们回顾性分析了2005年至2017年NAC后的B-pCR、N-pCR和总（乳腺和腋窝淋巴结）病理完全缓解（T-pCR）情况，以评估差异和结果。共有968例诊断为cT1-4c、N1-2和M0乳腺癌的患者纳入研究。中位年龄为49岁，中位随访时间为45个月。这些患者中，213例达到T-pCR，31例达到B-pCR但腋窝淋巴结病理未完全缓解（N-non pCR），245例达到N-pCR但乳腺病理未完全缓解（B-non pCR），479例在NAC后达到总（乳腺和腋窝淋巴结）病理未完全缓解（T-non pCR）。激素受体阴性、人表皮生长因子受体2阳性（HR(-)HER)2(+)）亚型的B-pCR和N-pCR率最高，而HR(+)HER2(-)亚型的B-pCR率最低。N-pCR率与B-pCR率相关（P<0.001），但在所有亚型中均高于B-pCR率。T-pCR、B-pCR和N-pCR患者的5年总生存率（OS）分别为91.2%、91.7%和91.9%。对于非pCR、非pCR和非pCR，5年OS率分别为73.6%、78.9%和74.7%（P<0.0001）。B-non pCR患者的复发风险低于T-non pCR或N-non-pCR患者，尽管他们之间的OS没有差异。总之，在所有内在亚型中，NAC后的N-pCR率高于B-pCR率，N-non pCR或T-non pCR患者的结局最差。
