POWER-PAK 评分可预测肿瘤对 3 个月术前内分泌治疗的反应。
The POWER-PAK Score Characterizes Tumor Response to 3 Months of Preoperative Endocrine Therapy.
机构信息
Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA.
Department of Pathology, University of Virginia, Charlottesville, VA, USA.
出版信息
Ann Surg Oncol. 2023 Oct;30(10):6034-6040. doi: 10.1245/s10434-023-13892-8. Epub 2023 Jul 15.
BACKGROUND
The Pre-Operative Window of Endocrine Therapy to Inform Radiation Therapy Decisions (POWER, NCT04272801) trial aims to determine whether 3 months of preoperative endocrine therapy (pre-ET) informs adjuvant radiation therapy decisions among older women with early stage, ER-positive breast cancer. We propose the POWER Pathologic Assessment and Ki-67 (POWER-PAK) scoring system to characterize the histologic effects of pre-ET.
METHODS
Histologic evaluation was performed on core biopsy and lumpectomy specimens from 37 POWER trial participants who completed pre-ET and surgery. The POWER-PAK score consists of tumor regression, decrease in Ki-67 expression, and ER expression, each ranging from 0 to 2. Scores were aggregated to create the POWER-PAK score with a range from 0 to 6. Participants with no residual tumor were labelled 6-NRT.
RESULTS
ER expression did not decrease after pre-ET. Ki-67 decreased from 13% in biopsy specimens to 5% in the lumpectomy specimens (p < 0.001). Cellularity decreased from 40% to 23% (p < 0.001). There was heterogeneity of POWER-PAK scores ranging from 2 to 6-NRT: score of 2, n = 2 (5.4%); 4, n = 8 (21.6%); 5, n = 4 (10.8%); 6, n = 16 (43.2%); and 6-NRT, n = 7 (18.9%). Participants with a score ≥ 5 were more likely to have smaller tumors after pre-ET compared with those with a score < 5 (p = 0.04).
CONCLUSIONS
The tumor responses following treatment with pre-ET are heterogenous. We propose that the POWER-PAK scoring system can be used to quantify response to pre-ET. Future studies will explore the use of POWER-PAK to support informed decision-making for adjuvant therapy options for older women with early stage breast cancer.
背景
内分泌治疗前窗以告知放疗决策（POWER，NCT04272801）试验旨在确定 3 个月的术前内分泌治疗（术前 ET）是否能为早期 ER 阳性乳腺癌的老年女性提供辅助放疗决策信息。我们提出了 POWER 病理性评估和 Ki-67（POWER-PAK）评分系统，以描述术前 ET 的组织学效应。
方法
对 37 名完成术前 ET 和手术的 POWER 试验参与者的核心活检和肿瘤切除术标本进行组织学评估。POWER-PAK 评分由肿瘤消退、Ki-67 表达下降和 ER 表达组成，每项评分范围为 0 至 2 分。评分汇总后，POWER-PAK 评分范围为 0 至 6 分。无残余肿瘤的患者标记为 6-NRT。
结果
ER 表达在术前 ET 后没有下降。Ki-67 从活检标本中的 13%降至肿瘤切除术标本中的 5%（p<0.001）。细胞密度从 40%降至 23%（p<0.001）。POWER-PAK 评分范围从 2 到 6-NRT 不等，2 分者 2 例（5.4%），4 分者 8 例（21.6%），5 分者 4 例（10.8%），6 分者 16 例（43.2%），6-NRT 者 7 例（18.9%）。与评分<5 者相比，评分≥5 者的肿瘤在术前 ET 后更小（p=0.04）。
结论
接受术前 ET 治疗后的肿瘤反应是异质的。我们提出，POWER-PAK 评分系统可用于量化对术前 ET 的反应。未来的研究将探索使用 POWER-PAK 来支持为早期乳腺癌老年女性提供辅助治疗方案的决策。
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