Neoadjuvant Chemotherapy of Breast Cancer: Tumor Markers as Predictors of Pathologic Response, Recurrence, and Survival
Neoadjuvant Chemotherapy of Breast Cancer: Tumor Markers as Predictors of Pathologic Response, Recurrence, and Survival
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DOI：
10.1111/j.1524-4741.2010.00935.x
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发表时间：
2010-07-01
期刊：
影响因子：
2.1
通讯作者：
Beatty, J. David
中科院分区：
文献类型：
--
作者：
Precht, Lisa M.;Lowe, Kimberly A.;Beatty, J. David
本研究报告了肿瘤标志物雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER 2）在预测乳腺癌对新辅助化疗反应中的价值。社区癌症中心前瞻性维护的乳腺癌数据库包含超过8,000例患者记录。自1989年以来，464例患者接受了新辅助化疗，随后进行手术切除，并进行了ER和PR检测。雌激素受体和/或PR阳性患者被认为是激素受体（HR）阳性。368例患者的人表皮生长因子受体2状态可用。评估总、乳腺和淋巴结病理学完全缓解（pCR）率、复发率和总生存率。HR阴性（HR-）患者的总pCR率和乳腺pCR率（分别为26%和32%）高于HR阳性（HR+）患者（分别为4%和7%; p < 0.001）。与HR+患者相比，HR）患者的复发率更高（38%比22%; p < 0.001），复发时间更短（1.28比2.14年; p < 0.001），总生存率降低（67%比81%; p < 0.001）。接受新辅助曲妥珠单抗（NAT）治疗的人表皮生长因子受体2阳性患者表现出更高的总pCR（34% vs 13%; p = 0.008），乳腺pCR（37% vs 17%; p = 0.02），以及淋巴结pCR率（47%对23%; p = 0.05）。此外，接受NAT治疗的HER 2+患者的复发率较低（5%对42%; p < 0.001）和总生存率增加（97%对68%; p < 0.001）。总之，乳腺癌HR状态可预测新辅助化疗后的总体和乳腺pCR率。尽管HR患者从新辅助化疗中获得了更大的病理学反应方面的益处，但他们在复发和生存方面的结局更差。激素受体阳性患者对新辅助化疗的反应明显较低，但总体结局明显较好。对于HR）和HR+，加入NAT治疗HER 2+肿瘤可获得更好的上级缓解和结局。
This study reports the value of the tumor markers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in predicting the response of breast cancer to neoadjuvant chemotherapy. A community cancer center prospectively maintained breast cancer database containing over 8,000 patient records was used. Since 1989, 464 patients were treated with neoadjuvant chemotherapy followed by surgical resection and were tested for ER and PR. Estrogen receptor and/or PR positive patients were considered hormone receptor (HR) positive. Human epidermal growth factor receptor 2 status was available on 368 patients. Total, breast, and nodal pathologic complete response (pCR) rates, recurrence, and overall survival were assessed. Total and breast pCR rates were higher in HR negative (HR-) patients (26% and 32%, respectively) than in HR positive (HR+) patients (4% and 7%, respectively; p < 0.001). Compared to HR+ patients, HR) patients had higher recurrence rates (38% versus 22%; p < 0.001), a shorter time to recurrence (1.28 versus 2.14 years; p < 0.001), and decreased overall survival (67% versus 81%; p < 0.001). Human epidermal growth factor receptor 2 positive patients treated with neoadjuvant trastuzumab (NAT) demonstrated higher total pCR (34% versus 13%; p = 0.008), breast pCR (37% versus 17%; p = 0.02), and nodal pCR rates (47% versus 23%; p = 0.05) compared to HER2+ patients not treated with NAT. Furthermore, HER2+ patients who received NAT had lower recurrence rates (5% versus 42%; p < 0.001) and increased overall survival (97% versus 68%; p < 0.001). In conclusion, breast cancer HR status is predictive of total and breast pCR rates after neoadjuvant chemotherapy. Although HR) patients derive greater benefit from neoadjuvant chemotherapy in terms of pathologic response, they have worse outcomes in terms of recurrence and survival. Hormone receptor positive patients demonstrate significantly less response to neoadjuvant chemotherapy, but significantly better overall outcome. For both HR) and HR+, addition of NAT for HER2+ tumors results in both a superior response and outcome.