Immunohistochemical Surrogate Markers of Breast Cancer Molecular Classes Predicts Response to Neoadjuvant Chemotherapy A Single Institutional Experience With 359 Cases
Immunohistochemical Surrogate Markers of Breast Cancer Molecular Classes Predicts Response to Neoadjuvant Chemotherapy A Single Institutional Experience With 359 Cases
复制标题
DOI：
10.1002/cncr.24876
复制
发表时间：
2010-03-15
期刊：
影响因子：
6.2
通讯作者：
Ahrendt, Gretchen M.
中科院分区：
文献类型：
--
作者：
Bhargava, Rohit;Beriwal, Sushil;Ahrendt, Gretchen M.
背景：使用表达谱分析，新辅助化疗 (NACT) 的完全病理反应主要见于“ERBB2”和“基底样”肿瘤。我们假设使用半定量免疫组织化学可以预测雌激素受体 (ER)、孕激素受体 (PR) 和人表皮生长因子受体 2 (HER2) 的类似反应。方法：使用 ER、PR 和 HER2 将 359 个接受 NACT 治疗的肿瘤分为 6 组：luminal A（强 ER+、HER2 阴性）、luminal B（弱至中度 ER+、HER2 阴性）、三阴性（ER、PR 和 HER2 阴性）、ERBB2（ER 和 PR 阴性，但 HER2+）、luminal A-HER2 混合型（强 ER+ 和 HER2 阴性） HER2+) 和 Luminal B-HER2 混合体（弱至中度 ER+ 和 HER2+）。完全病理反应定义为乳房和区域淋巴结不存在浸润性癌。结果：13%（359 人中的 48 人）表现出完全病理反应。完全病理缓解率最高的是 ERBB2（33%；57 例中的 19 例）和三阴性（30%；79 例中的 24 例）肿瘤类别。在 ER+“分子”组中，管腔 B-HER2 杂交肿瘤的完全病理缓解率最高，为 8%（24 例中的 2 例）。其余 ER+ 肿瘤的完全病理缓解率非常低，为 1.5%（198 例中的 3 例）。实现完全病理缓解的患者的 5 年生存率为 96%，而未能实现完全病理缓解的患者的 5 年生存率为 75%。与 ER 阳性组相比，ER 阴性组（ERBB2 和三阴性）的总生存率较差。结论：我们证实了最近定义的“三阴性悖论”，或者更确切地说“激素受体阴性悖论”，即尽管对 NACT 的反应最好，但 ERBB2 和三阴性肿瘤显示出最差的总生存率，因为残留疾病的患者复发率较高。癌症 2010；116：1431-9。 (C) 2070 美国癌症协会。
BACKGROUND: Complete pathologic response to neoadjuvant chemotherapy (NACT) is predominantly seen in "ERBB2" and "basal-like" tumors using expression profiling. We hypothesize that a similar response could be predicted using semiquantitative immunohistochemistry for estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2). METHODS: ER, PR, and HER2 were used to classify 359 tumors treated with NACT into 6 groups: luminal A (strong ER+, HER2 negative), luminal B (weak to moderate ER+, HER2 negative), triple negative (negative for ER, PR, and HER2), ERBB2 (negative for ER and PR, but HER2+), luminal A-HER2 hybrid (strong ER+ and HER2+), and luminal B-HER2 hybrid (weak to moderate ER+ and HER2+). Complete pathologic response was defined as absence of invasive carcinoma in the breast and regional lymph nodes. RESULTS: Thirteen percent (48 of 359) demonstrated complete pathologic response. The highest rate of complete pathologic response was seen in ERBB2 (33%; 19 of 57) and triple negative (30%; 24 of 79) tumor classes. Among the ER+ "molecular" group, the highest rate of complete pathologic response was seen among luminal B-HER2 hybrid tumors, 8% (2 of 24). Remainder of ER+ tumors demonstrated a very low rate of complete pathologic response, 1.5% (3 of 198). The 5-year survival for patients achieving complete pathologic response was 96% compared with 75% in patients that failed to achieve complete pathologic response. The overall survival was worse in the ER-negative group (ERBB2 and triple negative) compared with the ER-positive group. CONCLUSIONS: We confirm the recently defined "triple negative paradox," or rather "hormone receptor negative paradox," that despite the best response to NACT, ERBB2 and triple negative tumors show the worst overall survival because of higher relapse among those with residual disease. Cancer 2010;116:1431-9. (C) 2070 American Cancer Society.