Rella Rossella, Belli Paolo, Romanucci Giovanna, Bufi Enida, Clauser Paola, Masiello Valeria, Marazzi Fabio, Morciano Francesca, Gori Elisabetta, Tommasini Oscar, Fornasa Francesca, Conti Marco
UOC Diagnostica Per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122, Rome, Italy.
UOC Di Radiologia Toracica e Cardiovascolare, Dipartimento Di Diagnostica Per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
Breast Cancer Res Treat. 2025 Feb;210(1):157-166. doi: 10.1007/s10549-024-07548-8. Epub 2024 Nov 12.
To analyze the relationship between mammographic breast density and tumor response and outcome at follow-up, in terms of overall survival (OS) and disease-free survival (DFS), in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy (NACT).
A total of 228 women (mean age, 47.6 years ± 10 [SD]; range: 24-74 years) with invasive breast cancer who underwent NACT were included in this observational retrospective study. Clinical, radiological and histopatological data were retrieved. Categorization of breast density was performed by two radiologists in consensus on mammography acquired at the time of diagnosis according to BI-RADS categories. Association between density categories and tumor response was analyzed in the overall population and in subgroups defined by menopausal status, tumor phenotype and stage at diagnosis. Kaplan-Meier (KM) curves were used to estimate the OS and DFS probabilities. Subgroup analyses based on menopausal status and tumor phenotype were performed.
A total of 30 patients (13.2%) achieved pathological complete response (pCR). No association between density categories and pCR was found (P = 0.973), even at subgroups analysis. The median follow-up time was 92 months. Patients with dense breast showed the longest DFS (P = 0.0094), results confirmed in premenopausal patients (P = 0.0024) and in triple negative breast cancers (P = 0.0292). Density category did not show a statistically significant association with OS.
Breast cancer patients receiving NACT with extremely dense breasts showed better DFS. No evidence of breast density as a predictive marker for complete pathological response or as a prognostic factor in terms of OS was found.
分析接受新辅助化疗（NACT）的单侧浸润性乳腺癌患者乳腺钼靶密度与随访时肿瘤反应及总生存（OS）和无病生存（DFS）结局之间的关系。
本观察性回顾性研究纳入了228例接受NACT的浸润性乳腺癌女性患者（平均年龄47.6岁±10[标准差]；范围：24 - 74岁）。收集临床、放射学和组织病理学数据。由两名放射科医生根据BI-RADS分类对诊断时获取的乳腺钼靶图像进行乳腺密度分类，达成共识。在总体人群以及根据绝经状态、肿瘤表型和诊断时分期定义的亚组中分析密度分类与肿瘤反应之间的关联。采用Kaplan-Meier（KM）曲线估计OS和DFS概率。进行基于绝经状态和肿瘤表型的亚组分析。
共有30例患者（13.2%）达到病理完全缓解（pCR）。即使在亚组分析中，也未发现密度分类与pCR之间存在关联（P = 0.973）。中位随访时间为92个月。乳腺致密的患者DFS最长（P = 0.0094），在绝经前患者（P = 0.0024）和三阴性乳腺癌患者（P = 0.0292）中得到证实。密度分类与OS未显示出统计学上显著的关联。
接受NACT且乳腺极度致密的乳腺癌患者DFS较好。未发现乳腺密度作为完全病理缓解的预测标志物或OS方面的预后因素的证据。
