A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival
A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival
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DOI：
10.1016/s0960-9776(03)00106-1
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发表时间：
2003-10-01
期刊：
影响因子：
3.9
通讯作者：
Heys, SD
中科院分区：
文献类型：
--
作者：
Ogston, KN;Miller, ID;Heys, SD
原发性乳腺癌对化疗的临床和完全病理学反应已被证明是生存的重要预后因素。然而，大多数患者对初次化疗没有完全的病理学反应，较低程度的组织学反应的意义尚不确定，预后意义也未知。本研究旨在评价一种新的乳腺癌组织学分级系统，以评估乳腺癌对原发性化疗的反应，并确定该系统是否具有预后价值。所有患者在化疗前后均接受了原发性乳腺肿瘤评估。在完成化疗（乳房切除术或广泛局部切除术伴腋窝手术）后切除残留肿瘤。对切除的组织进行评估，并使用五点组织学分级系统对化疗反应进行分级，该系统的基本特征是肿瘤细胞减少;与治疗前的芯活检进行比较。所有患者均随访5年以上。采用对数秩检验比较病理学反应、5年总生存率和无病生存率，所有患者的5年总生存率为71%。5年无病期占60%。使用这种新的分级系统的病理反应与总生存期（P = 0.02）和无病间隔（P = 0.04）之间存在显著相关性。在已知预后因素的多变量分析中，米勒/Payne分级系统是患者总生存率的独立预测因子，该分级系统评估了原发性化疗的组织学反应，可以预测接受此类治疗的大型和局部晚期乳腺癌患者的总生存率和无病期。组织学缓解程度与总体和无病生存期的关系已在单变量和多变量分析中得到证实，可能在接受初次化疗的局部晚期乳腺癌患者的临床管理中发挥重要作用。(C)2003 Elsevier Ltd.保留所有权利。
The clinical and complete pathological response of a primary breast cancer to chemotherapy has been shown to be an important prognostic for survival. However, the majority of patients do not experience a complete pathological response to primary chemotherapy and the significance of lesser degrees of histological response is uncertain and the prognostic significance is unknown. The purpose of this study was to evaluate a new histological grading system to assess response of breast cancers to primary chemotherapy and to determine if such a system has prognostic value.A consecutive series of 176 patients with large (greater than or equal to4cm) and locally advanced breast cancers were treated with multimodality therapy comprising primary chemotherapy, surgery, radiotherapy and tamoxifen. All underwent assessment of the primary breast tumour before and after completion of chemotherapy. Residual tumour was excised after completion of chemotherapy (mastectomy or wide local excision with axillary surgery). The removed tissue was assessed and response to chemotherapy graded using a five-point histological grading system based with the fundamental feature being a reduction in tumour cellularity; comparison being made with a pre-treatment core biopsy. All patients were followed up for 5 years or more. Pathological responses were compared to 5 year overall survival and disease-free survival using log rank tests.The overall 5-year survival for all patients was 71%. and 5 year disease free interval was 60%. There was a significant correlation between pathological response using this new grading system and both overall survival (P = 0.02) and disease-free interval (P = 0.04). In a multivariate analysis of known prognostic factors, the Miller/Payne grading system was an independent predictor of overall patient survival.This grading system, which assesses the histological response to primary chemotherapy, can predict overall survival and disease-free interval in patients with large and locally advanced breast cancers treated with such therapy. The relationship of degree of histological response to overall and disease-free Survival has been shown in univariate and multivariate analyses and could potentially have an important role in the clinical management of patients with locally advanced breast cancer undergoing primary chemotherapy. (C) 2003 Elsevier Ltd. All rights reserved.