Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy
Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy
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DOI：
10.1200/jco.2005.02.5023
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发表时间：
2005-12-20
影响因子：
45.3
通讯作者：
Valero, V
中科院分区：
文献类型：
--
作者：
Hennessy, BT;Hortobagyi, GN;Valero, V
目的原发性乳腺肿瘤化疗后病理完全缓解(PCT)与较高的无复发生存率(RFS)和总生存率(OS)相关。本研究的目的是确定对经细胞学证实的腋窝淋巴结(ALN)转移患者进行聚合酶链式反应(PCR)的长期预后。手术后，患者被细分为有和没有残留ALN癌的患者。结果在接受治疗的925例患者中，有403例经细胞学证实为ALN转移。89例患者(22%)在PCT后获得了ALN-PCR。与未行ALN聚合酶链式反应的患者相比，接受ALN聚合酶链式反应的患者的5年CIS和RFS分别为93%[95%CI，87.5~98.51]和87%[95%CI，79.7~94.31 vs 72%[95%CI，66.5~77.5]和60%[95%CI，54.1~65.9]；P<；.0001。原发灶残留不影响ALN-PCR术的预后。尽管紫杉烷并不能改善ALN-PCR后的结果，但联合使用以蒽环类药物/紫杉烷为基础的PCT可显著增加ALN-PCR。我们构建了一个诺模图，显示没有从新辅助性蒽环类药物获益的患者不太可能从随后的紫杉类药物中受益。结论ALN聚合酶链式反应与良好的预后相关，即使在原发肿瘤残留的情况下也是如此，这表明原发细胞和转移细胞之间存在生物学差异。ALN聚合酶链式反应是长期预后的早期替代指标。初始PCT的反应对指导后续治疗具有重要的潜力。
Purpose Pathologic complete remission (pCR) of primary breast tumors after primary chemotherapy (PCT) is associated with higher relapse-free survival (RFS) and overall survival (OS) rates. The purpose of this study was to determine long-term outcome in patients achieving pCR of cytologically proven axillary lymph node (ALN) metastases.Methods Patients with cytologically documented ALN metastases were treated in five prospective PCT trials. After surgery, patients were subdivided into those with and without residual ALN carcinoma. Survival was calculated by the Kaplan-Meier method.Results Of 925 patients treated, 403 patients had cytologically confirmed ALN metastases. Eighty-nine patients (22%) achieved ALN pCR after PCT. Compared with the group without ALN pCR, 5-year CIS and RFS were improved in patients achieving ALN pCR (93% [95% Cl, 87.5 to 98.51 and 87% [95% Cl, 79.7 to 94.31 v 72% [95% Cl, 66.5 to 77.5] and 60% [95% Cl, 54.1 to 65.9], respectively; P < .0001). Residual primary tumor did not affect outcome of those with ALN pCR. Combination anthracycline/taxane-based PCT resulted in significantly more ALN pCRs, although outcome after ALN pCR was not improved by taxanes. We constructed a nomogram demonstrating that patients who do not benefit from neoadjuvant anthracyclines are unlikely to benefit from subsequent taxanes.Conclusion ALN pCR is associated with an excellent prognosis, even with a residual primary tumor, pointing to biologic differences between primary and metastatic cells. ALN pCR represents an early surrogate marker of long-term outcome. Response to initial PCT has important potential as a guide to subsequent therapy.