Pathologic response after neoadjuvant chemotherapy predicts locoregional control in patients with triple negative breast cancer
Pathologic response after neoadjuvant chemotherapy predicts locoregional control in patients with triple negative breast cancer
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DOI：
10.1016/j.adro.2017.01.012
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发表时间：
2017-04-01
影响因子：
2.3
通讯作者：
Einck, John P.
中科院分区：
文献类型：
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作者：
Chen, Victor E.;Gillespie, Erin F.;Einck, John P.
目的：我们的目标是确定三阴性乳腺癌（TNBC）新辅助化疗后的病理反应对辅助放疗后局部复发（LRR）和无病生存（DFS）的影响。方法和材料：这是一项机构审查委员会批准的对接受新辅助化疗的临床I-III期乳腺癌患者的回顾性图表审查，1997年至2015年间进行了局部手术（乳房保留或乳房切除术）和辅助放射治疗。对病历进行了审查，包括临床分期、肿瘤分级和亚型、新辅助化疗方案、手术类型、病理分期、放射治疗的使用、复发的日期和位置以及死亡日期。采用免疫组化和组织学分级确定分子亚型。ypT 0和ypN 0分别定义为乳腺或淋巴结中无残留浸润性疾病。LRR定义为乳房、胸壁或局部淋巴结内的任何失败。进行统计学分析; LRR和DFS率超过30个月，从Kaplan-Meier plots.Results确定：94例TNBC患者进行了分析，其中72人接受放射治疗。分离该亚组进行进一步研究。该组的中位随访时间为32.5个月。病理学完全缓解率（pCR）为36%，乳腺和/或淋巴结有无疾病是LRR的显著预测因素。在接受放射治疗的TNBC患者中，41例ypT+患者的30个月LRR为22%，而31例ypT 0患者的30个月LRR为0%（P=.003），31例ypN+患者中为23%，41例ypN 0患者中为5%（P= 0.016），46例乳腺或淋巴结残留病变患者中为20%，而26例pCR患者中为0%（P= 0.015）。接受乳房肿瘤切除术与乳房切除术的患者之间的LRR率差异无显著性（分别为8%和17%）。此外，有残留疾病的患者的DFS事件发生率更高（风险比，3.58; 95%置信区间，1.37-9.41; P= 0.006）。DFS的差异与接受的手术类型无显著相关性。结论：尽管使用辅助放疗，但与pCR患者相比，在手术时乳腺或淋巴结中有残留疾病的TNBC患者的局部区域失败率显著较高，DFS较低。加强残留疾病患者治疗的策略值得进一步研究。(C)2017作者爱思唯尔公司出版代表美国放射肿瘤学会
Purpose: Our goal was to determine the impact of pathologic response after neoadjuvant chemotherapy in triple negative breast cancer (TNBC) on the subsequent risk of locoregional recurrence (LRR) and disease-free survival (DFS) in the setting of adjuvant radiation therapy.Methods and materials: This was an institutional review board-approved retrospective chart review of patients with clinical stage I-III breast cancer treated with neoadjuvant chemotherapy, local surgery (breast conservation or mastectomy), and adjuvant radiation therapy between 1997 and 2015. Medical records were reviewed for clinical stage, tumor grade and subtype, neoadjuvant chemotherapy regimen, type of surgery, pathologic stage, use of radiation therapy, date and location of recurrence, and date of death. Molecular subtypes were defined using immunohistochemistry and histologic grade. ypT0 and ypN0 were defined as no residual invasive disease in breast or nodes, respectively. LRR was defined as any failure within the breast, chest wall, or regional lymph nodes. Statistical analysis was performed; LRR and DFS rates over 30 months were determined from Kaplan-Meier plots.Results: Ninety-four patients with TNBC were analyzed, of whom 72 received radiation therapy. This subgroup was isolated for further investigation. Median follow-up was 32.5 months in this group. The pathologic complete response (pCR) rate was 36%, and presence or absence of disease in breast and/or nodes was significantly predictive of LRR. In TNBC patients who received radiation therapy, 30-month LRR was 22% in 41 patients with ypT+ versus 0% in 31 patients with ypT0 (P=.003), 23% in 31 patients with ypN+ versus 5% in 41 patients with ypN0 (P=.016), and 20% in 46 patients with residual disease in breast or nodes versus 0% in 26 patients with pCR (P=.015). The difference in the rate of LRR between those who underwent lumpectomy versus mastectomy did not reach significance (8% vs 17%, respectively). Furthermore, patients with residual disease had a higher rate of DFS events (hazard ratio, 3.58; 95% confidence interval, 1.37-9.41; P=.006). The difference in DFS was not significantly associated with the type of surgery received.Conclusions: Patients with TNBC treated with neoadjuvant chemotherapy who have residual disease in the breast or lymph nodes at the time of surgery have significantly higher rates of locoregional failure and lower DFS compared with those with a pCR despite the use of adjuvant radiation therapy. Strategies to intensify therapy for patients with residual disease warrant further investigation. (C) 2017 the Authors. Published by Elsevier Inc. on behalf of the American Society for Radiation Oncology.