Bozer Ahmet, Yilmaz Cengiz, Çetin Tunçez Hülya, Kocatepe Çavdar Demet, Adıbelli Zehra Hilal
Department of Radiology, Izmir City Hospital, Izmir, Turkey.
Department of Radiology, Bozyaka Education and Research Hospital, Izmir, Turkey.
Breast Cancer (Dove Med Press). 2024 Dec 31;16:1005-1017. doi: 10.2147/BCTT.S495553. eCollection 2024.
In breast cancer (BC), neoadjuvant chemotherapy (NAC) responses can be categorized as concentric shrinkage (CS), non-concentric shrinkage (non-CS), and complete response, influencing surgical planning and survival. This study evaluates the correlation between histopathological and radiological response patterns in BC patients after NAC and their impact on overall survival (OS) and disease-free survival (DFS).
This retrospective study analyzed 168 BC patients who received NAC between 2018 and 2022. Tumor response was evaluated radiologically using MRI and histopathologically after surgery. Radiological response patterns were categorized into CS, non-CS, and radiological complete response (rCR). Histopathologically, patients were classified into CS, non-CS, and pathological complete response (pCR). Concordance between radiological and histopathological classifications was assessed using the kappa statistic. Survival outcomes, including OS and DFS, were analyzed using Kaplan-Meier methods.
Histopathological response patterns were distributed as CS (31.5%), non-CS (34.5%), and pCR (34%). Moderate agreement was observed between radiological and histopathological assessments (κ: 0.439, p < 0.001). Radiological evaluation identified 64% of CS, 50% of non-CS, and 74% of pCR cases accurately. Tumor molecular subtypes significantly correlated with both radiologic and histopathologic response patterns (p < 0.001). Subtype analysis revealed higher pCR rates in TN, HER2-enriched, and Luminal B-HER2(+) tumors, while non-CS was predominant in Luminal A tumors. No significant correlation was observed between histopathological or radiological patterns and OS (p: 0.291, p: 0.515) or DFS (p: 0.599, p: 0.899). However, patients achieving pCR tended to have better survival outcomes.
We observed moderate concordance between histopathological and radiological response patterns in BC patients after NAC, but discrepancies highlight the limitations of radiological evaluation alone. These patterns did not significantly correlate with prognosis. Higher pCR rates were associated with better outcomes, but response patterns alone may not predict survival, warranting further research in larger cohorts.
在乳腺癌（BC）中，新辅助化疗（NAC）反应可分为同心收缩（CS）、非同心收缩（非CS）和完全缓解，这会影响手术规划和生存。本研究评估了BC患者接受NAC后组织病理学和放射学反应模式之间的相关性及其对总生存期（OS）和无病生存期（DFS）的影响。
这项回顾性研究分析了2018年至2022年间接受NAC的168例BC患者。术后通过MRI进行放射学评估肿瘤反应，并进行组织病理学评估。放射学反应模式分为CS、非CS和放射学完全缓解（rCR）。在组织病理学上，患者分为CS、非CS和病理完全缓解（pCR）。使用kappa统计量评估放射学和组织病理学分类之间的一致性。使用Kaplan-Meier方法分析生存结局，包括OS和DFS。
组织病理学反应模式分布为CS（31.5%）、非CS（34.5%）和pCR（34%）。放射学和组织病理学评估之间观察到中度一致性（κ：0.439，p < 0.001）。放射学评估准确识别出64%的CS病例、50%的非CS病例和74%的pCR病例。肿瘤分子亚型与放射学和组织病理学反应模式均显著相关（p < 0.001）。亚型分析显示三阴型、HER2富集型和Luminal B-HER2(+)肿瘤的pCR率较高，而Luminal A肿瘤中以非CS为主。组织病理学或放射学模式与OS（p：0.291，p：0.515）或DFS（p：0.599，p：0.899）之间未观察到显著相关性。然而，达到pCR的患者往往有更好的生存结局。
我们观察到BC患者接受NAC后组织病理学和放射学反应模式之间存在中度一致性，但差异突出了仅靠放射学评估的局限性。这些模式与预后无显著相关性。较高的pCR率与更好的结局相关，但仅反应模式可能无法预测生存，需要在更大队列中进行进一步研究。
