Measurement of residual breast cancer burden to predict survival after Neoadjuvant chemotherapy
Measurement of residual breast cancer burden to predict survival after Neoadjuvant chemotherapy
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DOI：
10.1200/jco.2007.10.6823
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发表时间：
2007-10-01
影响因子：
45.3
通讯作者：
Pusztai, Lajos
中科院分区：
文献类型：
--
作者：
Symmans, W. Fraser;Peintinger, Florentia;Pusztai, Lajos
为了评估新辅助化疗后的残留病变，以改善通过评估病理反应所获得的预后信息，对382例患者进行了两种不同治疗队列的病理切片和报告：241例患者先用紫杉醇(T)序贯治疗，然后用氟尿嘧啶、阿霉素和环磷酰胺(FAC)治疗；141例患者用单一FAC方案治疗。在多因素COX回归分析中，残余癌负荷(RCB)作为一项连续指标，结合原发肿瘤(大小和细胞密度)和淋巴结转移(数目和大小)的病理测量来预测远处无复发生存(DRFS)。结果在包括年龄、治疗前临床分期、激素受体状态、激素治疗和病理反应(病理完全缓解[PCRv]和残余疾病[RD]；风险比=2.50；95%CI 1.70~3.69；P<；.001)的多因素模型中，RCB是独立的预后因素。微小RD(RCB-L)的预后与聚合酶链式反应(RCB-0)相同的患者占17%。广泛的RD(RCB-III)在13%的患者中与不良预后相关，无论激素受体状态、辅助激素治疗或美国癌症联合委员会残留疾病的病理阶段。结论常规病理资料所确定的RCB代表了RD的分布，是DRFS的一个重要预测因子，可用于确定近完全缓解和化疗耐药的类别。
Purpose To measure residual disease after neoadjuvant chemotherapy in order to improve the prognostic information that can be obtained from evaluating pathologic response.Patients and Methods Pathologic slides and reports were reviewed from 382 patients in two different treatment cohorts: sequential paclitaxel (T) then fluorouracil, doxorubicin, and cyclophosphamide (FAC) in 241 patients; and a single regimen of FAC in 141 patients. Residual cancer burden (RCB) was calculated as a continuous index combining pathologic measurements of primary tumor (size and cellularity) and nodal metastases (number and size) for prediction of distant relapse-free survival (DRFS) in multivariate Cox regression analyses.Results RCB was independently prognostic in a multivariate model that included age, pretreatment clinical stage, hormone receptor status, hormone therapy, and pathologic response (pathologic complete response [pCR] v residual disease [RD]; hazard ratio = 2.50; 95% Cl 1.70 to 3.69; P < .001). Minimal RD (RCB-l) in 17% of patients carried the same prognosis as pCR (RCB-0). Extensive RD (RCB-III) in 13% of patients was associated with poor prognosis, regardless of hormone receptor status, adjuvant hormone therapy, or pathologic American Joint Committee on Cancer stage of residual disease. The generalizability of RCB for prognosis of distant relapse was confirmed in the FAC-treated validation cohort.Conclusion RCB determined from routine pathologic materials represented the distribution of RD, was a significant predictor of DRFS, and can be used to define categories of near-complete response and chemotherapy resistance.