A combination of Nottingham prognostic index and IHC4 score predicts pathological complete response of neoadjuvant chemotherapy in estrogen receptor positive breast cancer.
A combination of Nottingham prognostic index and IHC4 score predicts pathological complete response of neoadjuvant chemotherapy in estrogen receptor positive breast cancer.
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诺丁汉预后指数和 IHC4 评分相结合可预测雌激素受体阳性乳腺癌新辅助化疗的病理完全缓解
DOI：
10.18632/oncotarget.13549
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发表时间：
2016-12-27
期刊：
影响因子：
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通讯作者：
Gong C
中科院分区：
文献类型：
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作者：
Tan W;Luo W;Jia W;Liang G;Xie X;Zheng W;Song E;Su F;Gong C
新辅助化疗（NAC）后病理完全缓解（pCR）预测对乳腺癌的临床决策非常重要。本研究旨在探讨诺丁汉预后指数（NPI）、免疫组化4（IHC 4）评分及二者联合应用的新的预测指标对NAC后雌激素阳性（ER+）乳腺癌的预测价值。我们回顾性收集了来自两个癌症中心的739例接受NAC的ER+乳腺癌患者的临床数据。我们开发了一种名为NPI+ IHC 4的新的预测生物标志物，用于在训练集（n=443）中预测ER+乳腺癌中的pCR，并在外部验证集（n=296）中对其进行验证。结果显示，在整个队列中，较低的IHC 4评分、NPI和NPI+ IHC 4与较高的pCR率显著相关。在研究集中，NPI+ IHC 4显示出更好的pCR预测敏感性和特异性（AUC 0.699，95% CI 0.626-0.772）高于IHC 4评分（AUC 0.613，95%CI 0.533-0.692）、NPI（AUC 0.576，95%CI 0.494-0.659）、肿瘤大小（AUC 0.556，95%CI 0.481-0.631）和TNM分期（AUC 0.521，95%CI 0.442-0.601）。在验证集中，NPI+ IHC 4对pCR的预测值（AUC 0.665，95% CI 0.579-0.751）优于IHC 4评分或NPI单独给药。此外，在研究和验证集中，具有较低IHC 4、NPI和NPI+ IHC 4评分的ER+患者具有显著更好的DFS。总之，NPI+ IHC 4可以预测NAC后的pCR和ER+乳腺癌的预后，这是一种成本效益分析，在指导临床实践中关于NAC的决策方面可能更有用。需要在更大患者队列的前瞻性临床试验中进行进一步验证。
Pathologic complete response (pCR) prediction after neoadjuvant chemotherapy (NAC) is important for clinical decision-making in breast cancer. This study investigated the predictive value of Nottingham prognostic index (NPI), Immunohistochemical four (IHC4) score and a new predictive index combined with them in estrogen-positive (ER+) breast cancer following NAC. We retrospectively gathered clinical data of 739 ER+ breast cancer patients who received NAC from two cancer centers. We developed a new predictive biomarker named NPI+IHC4 to predict pCR in ER+ breast cancer in a training set (n=443) and validated it in an external validation set (n=296). The results showed that a lower IHC4 score, NPI and NPI+IHC4 were significantly associated a high pCR rate in the entire cohort. In the study set, NPI+IHC4 showed a better sensitivity and specificity for pCR prediction (AUC 0.699, 95% CI 0.626-0.772) than IHC4 score (AUC 0.613, 95% CI 0.533-0.692), NPI (AUC 0.576, 95% CI 0.494-0.659), tumor size (AUC 0.556, 95% CI 0.481-0.631) and TNM stage (AUC 0.521, 95% CI 0.442-0.601). In the validation set, NPI+IHC4 had a better predictive value for pCR (AUC 0.665, 95% CI 0.579-0.751) than IHC4 score or NPI alone. In addition, ER+ patients with lower IHC4, NPI and NPI+IHC4 scores had significantly better DFS in both study and validation sets. In summary, NPI+IHC4 can predict pCR following NAC and prognosis in ER+ breast cancer, which is cost-effect and potentially more useful in guiding decision-making regarding NAC in clinical practice. Further validation is needed in prospective clinical trials with larger cohorts of patients.