Laboratory of Mammary Pathology, Department of Anatomical Pathology and Forensic Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Cancer Res Treat. 2024 Jan;56(1):178-190. doi: 10.4143/crt.2023.386. Epub 2023 Aug 1.
Neoadjuvant chemotherapy (NACT) can change invasive breast carcinomas (IBC) and influence the patients' overall survival time (OS). We aimed to identify IBC changes after NACT and their association with OS.
IBC data in pre- and post-NACT samples of 86 patients were evaluated and associated with OS.
Post-NACT tumors changed nuclear pleomorphism score (p=0.025); mitotic count (p=0.002); % of tumor-infiltrating inflammatory cells (p=0.016); presence of in situ carcinoma (p=0.001) and lymphovascular invasion (LVI; p=0.002); expression of estrogen (p=0.003), progesterone receptors (PR; p=0.019), and Ki67 (p=0.003). Immunohistochemical (IHC) profile changed in 26 tumors (30.2%, p=0.050). Higher risk of death was significatively associated with initial tumor histological grade III (hazard ratio [HR], 2.94), high nuclear pleomorphism (HR, 2.53), high Ki67 index (HR, 2.47), post-NACT presence of LVI (HR, 1.90), luminal B-like profile (HR, 2.58), pre- (HR, 2.26) and post-NACT intermediate mitotic count (HR, 2.12), pre- (HR, 4.45) and post-NACT triple-negative IHC profile (HR, 4.52). On the other hand, lower risk of death was significative associated with pre- (HR, 0.35) and post-NACT (HR, 0.39) estrogen receptor-positive, and pre- (HR, 0.37) and post-NACT (HR, 0.57) PR-positive. Changes in IHC profile were associated with longer OS (p=0.050). In multivariate analysis, pre-NACT grade III tumors and pre-NACT and post-NACT triple negative IHC profile proved to be independent factors for shorter OS.
NACT can change tumor characteristics and biomarkers and impact on OS; therefore, they should be reassessed on residual samples to improve therapeutic decisions.
新辅助化疗（NACT）可以改变浸润性乳腺癌（IBC）并影响患者的总生存时间（OS）。我们旨在确定 NACT 后 IBC 的变化及其与 OS 的关系。
评估了 86 例患者的 NACT 前后样本中的 IBC 数据，并与 OS 相关联。
NACT 后肿瘤的核多形性评分（p=0.025）；有丝分裂计数（p=0.002）；肿瘤浸润性炎症细胞的百分比（p=0.016）；原位癌（p=0.001）和脉管侵犯（LVI；p=0.002）的存在；雌激素（p=0.003）、孕激素受体（PR；p=0.019）和 Ki67（p=0.003）的表达。26 例肿瘤的免疫组化（IHC）谱发生变化（30.2%，p=0.050）。初始肿瘤组织学分级 III（风险比[HR]，2.94）、高核多形性（HR，2.53）、高 Ki67 指数（HR，2.47）、NACT 后 LVI 存在（HR，1.90）、管腔 B 样表型（HR，2.58）、术前（HR，2.26）和 NACT 后中等有丝分裂计数（HR，2.12）、术前（HR，4.45）和 NACT 后三阴性 IHC 谱（HR，4.52）与死亡风险显著相关。另一方面，雌激素受体阳性的术前（HR，0.35）和术后（HR，0.39）、孕激素受体阳性的术前（HR，0.37）和术后（HR，0.57）与较低的死亡风险显著相关。IHC 谱的变化与较长的 OS 相关（p=0.050）。在多变量分析中，术前 III 级肿瘤和术前和术后三阴性 IHC 谱被证明是 OS 较短的独立因素。
NACT 可改变肿瘤特征和生物标志物，并影响 OS；因此，应在残留样本中重新评估它们，以改善治疗决策。
