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预测早期三阴性乳腺癌病理反应的临床病理因素

Clinico-pathological factors predicting pathological response in early triple-negative breast cancer.

作者信息

Helal Clara, Djerroudi Lounes, Ramtohul Toulsie, Laas Enora, Vincent-Salomon Anne, Jin Maxime, Seban Romain-David, Bieche Ivan, Bello-Roufai Diana, Bidard Francois-Clement, Cottu Paul, Loirat Delphine, Carton Matthieu, Lerebours Florence, Kiavue Nicolas, Romano Emanuela, Bonneau Claire, Cabel Luc

机构信息

Department of Medical Oncology, Institut Curie, Paris, France.

Department of Pathology, Institut Curie, Paris, France.

出版信息

NPJ Breast Cancer. 2025 Feb 13;11(1):15. doi: 10.1038/s41523-025-00729-8.

Abstract

Pathological complete response (pCR) after neoadjuvant chemoimmunotherapy (NACi) is associated with improved patient outcomes in early triple-negative breast cancer (TNBC). This study aimed to identify factors associated with pCR after NACi. This cohort included all patients with stage II-III TNBC treated with NACi who underwent surgery at Institut Curie hospitals between 08/2021-06/2023. Among 208 patients, the overall pCR rate was 70% and was similar in ER < 1% (69%) and ER-low TNBC (73%, p = 0.6). In a multivariate model, Ki-67 ≥ 30% (OR 5.19 [1.73-17.3]), centralized TILs ≥ 30% (OR = 3.08 [1.42-7.04]), absence of DCIS at initial biopsy (OR = 2.56 [1.08-6.25]) and germline mutations in homologous recombination genes (OR = 9.50 [2.37-67.7]) remained strong independent predictors of pCR. These findings may guide treatment decisions in patients with TNBC undergoing NACi. Almost all patients with germline mutations in HR genes achieved pCR, supporting de-escalation trials. We suggest that ER-low tumors should be managed as TNBC tumors.

摘要

新辅助化疗免疫疗法(NACi)后的病理完全缓解(pCR)与早期三阴性乳腺癌(TNBC)患者预后改善相关。本研究旨在确定NACi后与pCR相关的因素。该队列包括2021年8月至2023年6月期间在居里研究所医院接受NACi治疗并接受手术的所有II-III期TNBC患者。在208例患者中,总体pCR率为70%,雌激素受体(ER)<1%的患者(69%)和ER低表达的TNBC患者(73%)相似(p=0.6)。在多变量模型中,Ki-67≥30%(比值比[OR]5.19[1.73-17.3])、集中肿瘤浸润淋巴细胞(TILs)≥30%(OR=3.08[1.42-7.04])、初次活检时无导管原位癌(DCIS)(OR=2.56[1.08-6.25])以及同源重组基因的胚系突变(OR=9.50[2.37-67.7])仍然是pCR的强有力独立预测因素。这些发现可能指导接受NACi治疗的TNBC患者的治疗决策。几乎所有HR基因胚系突变的患者都实现了pCR,支持降级试验。我们建议ER低表达肿瘤应按TNBC肿瘤进行管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc02/11825670/ce4cd80eca11/41523_2025_729_Fig1_HTML.jpg

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