Cellular Pathology, Queen Elizabeth Hospital, Birmingham B15 2GW, UK.
Histopathology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom 11352, Egypt.
Int J Mol Sci. 2024 Jul 5;25(13):7381. doi: 10.3390/ijms25137381.
Oestrogen receptor (ER)-positive breast cancer (BC) is generally well responsive to endocrine therapy. Neoadjuvant endocrine therapy (NAET) is increasingly being used for downstaging ER-positive tumours. This study aims to analyse the effect of NAET on a well-characterised cohort of ER-positive BC with particular emphasis on receptor expression. This is a retrospective United Kingdom (UK) multicentre study of 391 patients who received NAET between October 2012 and October 2020. Detailed analyses of the paired pre- and post-NAET morphological changes and hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) expression were performed. The median duration of NAET was 86 days, with median survival and overall survival rates of 380 days and 93.4%, respectively. A total of 90.3% of cases achieved a pathological partial response, with a significantly higher rate of response in the HER2-low cancers. Following NAET, BC displayed some pathological changes involving the tumour stroma including central scarring and an increase in tumour infiltrating lymphocytes (TILs) and tumour cell morphology. Significant changes associated with the duration of NAET were observed in tumour grade (30.6% of cases), with downgrading identified in 19.3% of tumours ( < 0.001). The conversion of ER status from positive to low or negative was insignificant. The conversion of progesterone receptor (PR) and HER2 status to negative status was observed in 31.3% and 38.1% of cases, respectively ( < 0.001). HER2-low breast cancer decreased from 63% to 37% following NAET in the paired samples. Significant morphological and biomarker changes involving PR and HER2 expression occurred following NAET. The findings support biomarker testing on pre-treatment core biopsies and post-treatment residual carcinoma.
雌激素受体（ER）阳性乳腺癌（BC）通常对内分泌治疗反应良好。新辅助内分泌治疗（NAET）越来越多地用于降期 ER 阳性肿瘤。本研究旨在分析 NAET 对一组特征明确的 ER 阳性 BC 患者的影响，特别强调受体表达。这是一项回顾性的英国（UK）多中心研究，纳入了 391 例于 2012 年 10 月至 2020 年 10 月期间接受 NAET 的患者。对术前和术后 NAET 的形态变化以及激素受体（HR）和人表皮生长因子受体 2（HER2）表达进行了详细分析。NAET 的中位持续时间为 86 天，中位生存和总生存率分别为 380 天和 93.4%。共有 90.3%的病例达到了病理学部分缓解，HER2 低表达癌症的缓解率明显更高。NAET 后，BC 显示出一些与肿瘤基质相关的病理学变化，包括中央瘢痕形成、肿瘤浸润淋巴细胞（TILs）增加和肿瘤细胞形态变化。与 NAET 持续时间相关的显著变化发生在肿瘤分级（30.6%的病例），19.3%的肿瘤降级（<0.001）。ER 状态从阳性转为低表达或阴性的情况并不显著。孕激素受体（PR）和 HER2 状态转为阴性的情况分别在 31.3%和 38.1%的病例中观察到（<0.001）。在配对样本中，NAET 后 HER2 低表达乳腺癌从 63%降至 37%。PR 和 HER2 表达的显著形态和生物标志物变化发生在 NAET 之后。这些发现支持在治疗前核心活检和治疗后残留癌中进行生物标志物检测。
