Predictive factors for the effectiveness of neoadjuvant chemotherapy and prognosis in triple-negative breast cancer patients
Predictive factors for the effectiveness of neoadjuvant chemotherapy and prognosis in triple-negative breast cancer patients
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DOI：
10.1007/s00280-010-1371-4
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发表时间：
2011-04-01
影响因子：
3
通讯作者：
Tsujinaka, Toshimasa
中科院分区：
文献类型：
--
作者：
Masuda, Hiroko;Masuda, Norikazu;Tsujinaka, Toshimasa
三阴性乳腺癌（TNBC）不能从分子靶向治疗（如内分泌治疗或抗HER 2治疗）中获益，因为它们缺乏这些分子靶点。另一方面，已显示TNBC对新辅助化疗（NAC）有反应。在本研究中，我们分析了近5年来在大坂国立医院接受NAC治疗的TNBC患者，以阐明NAC的预测因素和预后因素。（FEC 100：5 FU 500 mg/m2，表阿霉素100 mg/m2，环磷酰胺500 mg/m2，q3 w，4个疗程）和紫杉烷类2003年5月至2008年7月，紫杉醇80 mg/m2/qw，12个疗程或多西他赛75 mg/m2/q3 w，4个疗程。免疫组化法检测治疗前及手术后标本ER、PgR、HER-2、EGFR、细胞角蛋白5/6、Ki-67、p53及雄激素受体的表达。我们分析了临床病理因素和分子标志物对NAC反应和预后的影响，12例TNBC患者（36%）达到病理完全反应（pCR）。基底细胞样表型的pCR率显著低于非基底细胞样表型（分别为23%和64%：P = 0.02）。术前Ki-67（千分之一）和HER-2（2+）的高表达被认为是NAC疗效较好的预测因素。非pCR患者术前Ki-67表达与无病生存期（DFS）相关，NAC后Ki-67表达降低（< 50%）有利于无病生存;非基底细胞样表型、Ki-67和HER-2（2+）高表达是NAC的有利因素。然而，NAC后手术标本上Ki-67的高表达也是预后不良的因素。
Triple-negative breast cancers (TNBCs) do not derive benefit from molecular-targeted treatments such as endocrine therapy or anti-HER2 therapy because they lack those molecular targets. On the other hand, TNBCs have been shown to respond to neoadjuvant chemotherapy (NAC). In this study, we analyzed TNBC patients who were treated with NAC at Osaka National Hospital over a recent 5-year period to clarify the predictive factors for NAC and prognostic factors.Thirty-three TNBC patients underwent sequential NAC with anthracycline (FEC100: 5FU 500 mg/m(2), epirubicin 100 mg/m(2), and cyclophosphamide 500 mg/m(2)/q3w, 4 courses) and taxanes (paclitaxel 80 mg/m(2)/qw, 12 courses or docetaxel 75 mg/m(2)/q3w, 4 courses) from May 2003 to July 2008. Pre-therapeutical and surgical specimens were studied for expressions of ER, PgR, HER-2, EGFR, cytokeratin 5/6, Ki-67, p53 and androgen receptor by immunohistochemistry (IHC). We analyzed clinicopathological factors and molecular markers in regard to the response to NAC and prognosis.Pathological complete response (pCR) was achieved in 12 TNBC patients (36%). The pCR rate in the basal-like phenotype was significantly lower than in the non-basal-like phenotype (23 vs. 64%, respectively: P = 0.02). High pre-operative expressions of Ki-67 (a parts per thousand yen50%) and HER-2 (2+) were considered as predictive factors for a better response from NAC. Pre-operative Ki-67 expression showed a significant correlation with disease-free survival (DFS) and a lower expression of Ki-67 (< 50%) after NAC was favorable for DFS among non-pCR patients.A non-basal-like phenotype and higher expressions of Ki-67 and HER-2 (2+) were favorable factors for NAC. However, a higher expression of Ki-67 on the surgical specimen after NAC was also a poor prognostic factor.