在使用 MammaPrint 和 BluePrint 指导术前全身治疗决策后，乳腺癌患者的治疗反应和 5 年远处无转移生存结果。

Treatment response and 5-year distant metastasis-free survival outcome in breast cancer patients after the use of MammaPrint and BluePrint to guide preoperative systemic treatment decisions.

机构信息

Alexander Monro Ziekenhuis, Professor Bronkhorstlaan 10, 3723 MB Bilthoven, the Netherlands.

Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands.

出版信息

Eur J Cancer. 2022 May;167:92-102. doi: 10.1016/j.ejca.2022.03.003. Epub 2022 Apr 11.

DOI:10.1016/j.ejca.2022.03.003

PMID:35421703

Abstract

AIM

In the prospective neoadjuvant NBREaST II study, we measured the response to preoperative treatment and 5-year survival outcome in the molecular subgroups as determined by combining the MammaPrint and BluePrint.

METHODS

Between 2012 and 2016 we included 256 patients for whom MammaPrint and BluePrint were performed on pre-treatment core needle biopsies. The primary objective of the NBREaST II trial was to measure chemosensitivity or endocrine sensitivity in the molecular subgroups. Distant metastasis-free survival (DMFS), relapse-free survival (RFS) and breast cancer-specific survival (BCSS) were the endpoints for long-term follow-up.

RESULTS

MammaPrint and BluePrint molecular sub-typing reclassified 9% (24/256) of tumours, reassigning more responsive patients to the HER2-Type and Basal-Type, and less responsive patients to the Luminal-Type category. Patients with Luminal A-Type tumours (n = 67, 26% of the total cohort) had a poor response when treated with neoadjuvant chemotherapy (NCT), but had the highest 5-year DMFS outcome (91.4%; 95% CI 78.6-96.7) of all molecular subgroups. Out of the IHC/FISH defined HER2+ tumours (n = 41), 37% were not classified as HER2-Type by BluePrint. Notably, in BluePrint HER2-Type tumours, we observed a higher pCR rate, whereas the 5-year DMFS was lower compared to IHC/FISH-defined HER2+ tumours. The pCR rate and 5-year outcome for patients with Basal-Type tumours were similar to IHC/FISH-defined TN tumours.

CONCLUSION

These findings suggest that MammaPrint and BluePrint can predict chemosensitivity and 5-year outcomes more accurately compared to traditional pathological sub-typing, supporting informed decision-making.

摘要

目的

在前瞻性新辅助 NBREaST II 研究中，我们通过联合使用 MammaPrint 和 BluePrint 来确定分子亚组，测量了术前治疗的反应和 5 年的生存结果。

方法

在 2012 年至 2016 年间，我们纳入了 256 例接受术前核心针活检的患者，进行了 MammaPrint 和 BluePrint 检测。NBREaST II 试验的主要目的是测量分子亚组的化疗敏感性或内分泌敏感性。无远处转移生存（DMFS）、无复发生存（RFS）和乳腺癌特异性生存（BCSS）是长期随访的终点。

结果

MammaPrint 和 BluePrint 分子亚分型将 9%（24/256）的肿瘤重新分类，将更具反应性的患者分配到 HER2 型和基底型，而将反应性较差的患者分配到 Luminal 型。接受新辅助化疗（NCT）治疗的 Luminal A 型肿瘤患者（n=67，占总队列的 26%）反应不佳，但所有分子亚组中 5 年 DMFS 结果最好（91.4%；95%CI 78.6-96.7）。在 IHC/FISH 定义的 HER2+肿瘤（n=41）中，37%的肿瘤未被 BluePrint 归类为 HER2 型。值得注意的是，在 BluePrint HER2 型肿瘤中，我们观察到更高的 pCR 率，而 5 年 DMFS 低于 IHC/FISH 定义的 HER2+肿瘤。基底型肿瘤患者的 pCR 率和 5 年结局与 IHC/FISH 定义的 TN 肿瘤相似。