Long-term treatment efficacy in primary inflammatory breast cancer by hormonal receptor- and HER2-defined subtypes
Long-term treatment efficacy in primary inflammatory breast cancer by hormonal receptor- and HER2-defined subtypes
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DOI：
10.1093/annonc/mdt525
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发表时间：
2014-02-01
影响因子：
50.5
通讯作者：
Ueno, N. T.
中科院分区：
文献类型：
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作者：
Masuda, H.;Brewer, T. M.;Ueno, N. T.
这是第一项研究IBC的激素受体和HER 2亚型，并确定相关的治疗效果在一个大的数据集。将IBC患者分类为两种不同的亚型，TNBC和非TNBC，可预测长期预后。HR阳性的疾病，无论HER 2状态如何，预后较差，与HR阴性/HER 2阳性亚型没有差异。我们描述了临床参数和长期结局，并在一个大型IBC患者人群中比较了HR/HER 2亚型的病理完全缓解（pCR）率。我们还比较了接受靶向治疗（抗激素、抗HER 2）和未接受靶向治疗的IBC患者的无病生存期（DFS）和总生存期（OS）。我们回顾性分析了1989年1月至2011年1月期间在MD安德森癌症中心诊断为IBC并接受治疗的患者的记录。其中，527例患者接受了新辅助化疗，并有雌激素受体（ER）、孕激素受体（PR）和HER 2状态的可用信息。如果ER或PR状态为阳性，则认为HR状态为阳性。使用Kaplan-Meier方法，我们估计了从确定性手术开始的中位DFS和OS持续时间。使用考克斯比例风险回归模型，我们确定预后因素对DFS和OS的影响。结果按亚型进行比较。III期IBC的总体pCR率为15.2%，HR阳性/HER 2阴性亚型的pCR率最低（7.5%），HR阴性/HER 2阳性亚型的pCR率最高（30.6%）。HR阴性、HER 2阴性亚型（三阴性乳腺癌，TNBC）的生存率最差。HR阳性疾病，无论HER 2状态如何，预后不良，在OS或DFS方面与HR阴性/HER 2阳性亚型无差异。实现pCR、无血管浸润证据、非TNBC、辅助激素治疗和放疗与较长DFS和OS相关。在我们的IBC人群中，激素受体和HER 2分子亚型的预测和预后能力有限。IBC的所有分子亚型均预后不良。HR阳性状态并不一定意味着良好的预后。对于所有IBC亚型，在新辅助和辅助治疗环境中需要新的特异性治疗策略。
This is the first study to investigate IBC in terms of hormone receptor and HER2 subtypes and to determine associated treatment efficacy in a large dataset. Classifying IBC patients into two distinct subtypes, TNBC and non-TNBC, predicts long-term prognosis. HR-positive disease, irrespective of HER2 status, had poorer prognosis that did not differ from that of the HR-negative/HER2-positive subtype.Subtypes defined by hormonal receptor (HR) and HER2 status have not been well studied in inflammatory breast cancer (IBC). We characterized clinical parameters and long-term outcomes, and compared pathological complete response (pCR) rates by HR/HER2 subtype in a large IBC patient population. We also compared disease-free survival (DFS) and overall survival (OS) between IBC patients who received targeted therapies (anti-hormonal, anti-HER2) and those who did not.We retrospectively reviewed the records of patients diagnosed with IBC and treated at MD Anderson Cancer Center from January 1989 to January 2011. Of those, 527 patients had received neoadjuvant chemotherapy and had available information on estrogen receptor (ER), progesterone receptor (PR), and HER2 status. HR status was considered positive if either ER or PR status was positive. Using the Kaplan-Meier method, we estimated median DFS and OS durations from the time of definitive surgery. Using the Cox proportional hazards regression model, we determined the effect of prognostic factors on DFS and OS. Results were compared by subtype.The overall pCR rate in stage III IBC was 15.2%, with the HR-positive/HER2-negative subtype showing the lowest rate (7.5%) and the HR-negative/HER2-positive subtype, the highest (30.6%). The HR-negative, HER2-negative subtype (triple-negative breast cancer, TNBC) had the worst survival rate. HR-positive disease, irrespective of HER2 status, had poor prognosis that did not differ from that of the HR-negative/HER2-positive subtype with regard to OS or DFS. Achieving pCR, no evidence of vascular invasion, non-TNBC, adjuvant hormonal therapy, and radiotherapy were associated with longer DFS and OS.Hormone receptor and HER2 molecular subtypes had limited predictive and prognostic power in our IBC population. All molecular subtypes of IBC had a poor prognosis. HR-positive status did not necessarily confer a good prognosis. For all IBC subtypes, novel, specific treatment strategies are needed in the neoadjuvant and adjuvant settings.