Sataloff D M, Mason B A, Prestipino A J, Seinige U L, Lieber C P, Baloch Z
Department of Surgery, Graduate Hospital, Philadelphia, PA.
J Am Coll Surg. 1995 Mar;180(3):297-306.
The prognosis for patients with locally advanced carcinoma of the breast remains poor. This study examines the pathologic evidence of response of the mammary tumor and axillary nodes after preoperative chemotherapy. We sought to determine if there was a relationship between the histologic response and clinical outcome.
Between 1987 and 1992, 36 patients with locally advanced carcinoma of the breast received three cycles of chemotherapy after incisional biopsy. Modified radical mastectomy was then performed. The breast and axillary nodes were examined pathologically for therapeutic effect and a grading scale was assigned. Postoperatively, patients received completion chemotherapy with the same agents used preoperatively followed by radiation therapy to the chest wall.
Fourteen tumors (39 percent) showed near total therapeutic effect, five (14 percent) showed greater than 50 percent but less than total effect, 12 (33 percent) showed less than 50 percent effect, and five (14 percent) showed no effect. Nodal positivity was seen in 61 percent of the patients. Overall clinical response to induction chemotherapy was seen in 86 percent of the patients. There was poor correlation between clinical and pathologic response. Only 50 percent of the patients with complete clinical response were pathologically free of disease. Patients with excellent pathologic therapeutic response had a 79 percent overall five-year survival rate compared with 34 percent for tumors with a lesser response. This was irrespective of nodal status. While pathologic response was critical in determining outcome, clinical response was not.
These results indicate that patients whose tumors have the best pathologic response to induction chemotherapy experience the best outcome.
局部晚期乳腺癌患者的预后仍然很差。本研究检查了术前化疗后乳腺肿瘤和腋窝淋巴结反应的病理证据。我们试图确定组织学反应与临床结果之间是否存在关联。
1987年至1992年间，36例局部晚期乳腺癌患者在切取活检后接受了三个周期的化疗。然后进行改良根治性乳房切除术。对乳房和腋窝淋巴结进行病理检查以评估治疗效果，并给出分级标准。术后，患者接受与术前相同药物的完成化疗，随后对胸壁进行放射治疗。
14个肿瘤（39%）显示出近乎完全的治疗效果，5个（14%）显示出大于50%但小于完全效果，12个（33%）显示出小于50%的效果，5个（14%）显示无效果。61%的患者出现淋巴结阳性。86%的患者对诱导化疗有总体临床反应。临床反应与病理反应之间相关性较差。只有50%临床完全缓解的患者病理上无疾病。病理治疗反应优秀的患者总体五年生存率为79%，而反应较差的肿瘤患者为34%。这与淋巴结状态无关。虽然病理反应对确定结果至关重要，但临床反应并非如此。
这些结果表明，肿瘤对诱导化疗有最佳病理反应的患者预后最佳。
