HISTOLOGICAL REGRESSION OF BREAST-CANCER AFTER PRIMARY (NEOADJUVANT) CHEMOTHERAPY
HISTOLOGICAL REGRESSION OF BREAST-CANCER AFTER PRIMARY (NEOADJUVANT) CHEMOTHERAPY
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DOI：
10.1055/s-2007-1022338
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发表时间：
1994-10-01
影响因子：
2.7
通讯作者：
OTTO, HF
中科院分区：
文献类型：
--
作者：
SINN, HP;SCHMID, H;OTTO, HF
局部晚期乳腺癌的原发性（新辅助）化疗是为了局部减少肿瘤肿块并提高可操作性。最近，原发性化疗的适应症。已扩展到保乳手术的术前治疗。在一项正在进行的临床试验中，我们检查了51例原发性化疗后乳腺癌的切除标本。这些患者接受了表柔比星/环磷酰胺的新辅助治疗，以缩小大的（> 3 cm）但可手术的肿瘤（乳腺X线摄影显示治疗前中位肿瘤大小为4.5 cm）。对肿瘤缓解进行了病理学评价，并与在所有病例中超过三分之二观察到的临床肿瘤消退进行了比较。我们使用半定量评分系统将回归变化从0到4进行分类（0 =无影响，1 =吸收和肿瘤硬化，2 =微小残留侵袭性肿瘤[< 0.5 cm]，3 =仅残留非侵袭性肿瘤，4 =未检测到肿瘤）。本研究的目的是客观地评价手术的改善，并将原发性肿瘤的组织学与治疗反应相关联。对于浸润性小叶癌，治疗后肿瘤大小的减少低于平均水平，与组织学肿瘤细胞减少量无关，这主要是由于这些肿瘤的基质含量。浸润性导管癌广泛或占主导地位的导管内成分也经历了肿瘤大小只有轻微的下降，这是因为缺乏与导管内成分的肿瘤反应。分化良好的管状癌对原发性化疗特别耐药。我们的结论是，乳腺癌的反应，主要化疗至少可以部分地解释肿瘤的分化，因此在一定程度上是可预测的预处理打孔活检的仔细评价。本文提出的半定量组织学评价评分允许治疗效果的分类，因此对进一步的治疗计划是有用的。
Primary (neoadjuvant) chemotherapy of locally advanced breast carcinomas is performed to locally reduce the tumour mass and to improve the operability. Recently, the indication for primary chemotherapy has. been extended for preoperative treatment in breast conserving surgery. In an ongoing clinical trial we examined the resection specimens of 51 mammary carcinomas after primary chemotherapy. These patients had received a neoadjuvant therapy with epirubicine/cyclophosphamide for size reduction of large (> 3 cm) but operable tumours (pretreatment median tumour size 4.5 cm by mammography). The tumour response was evaluated pathologically and copared with the clinical tumour regression that was observed in over two-thirds of all cases. We classified the regressive changes using a semiquantitative scoring system from 0 to 4 (0 = no effect, 1 = resorption and tumour sclerosis, 2 = minimal residual invasive tumour [< 0.5 cm], 3 = residual noninvasive tumour only, 4 = no tumour detectable). The aim of this study was to evaluate the improvement of operability objectively and to correlate the histology of the primary tumour with the response to treatment. With invasive lobular carcinomas, the tumour size after therapy was reduced less than average and irrespective of the amount of histological tumour cell reduction, largely due to the stromal content of these neoplasms. Invasive ductal carcinomas with extensive or predominant intraductal component also underwent only a slight decrease in tumour size; this was because of the lack of tumour response with the intraductal component. Well differentiated tubular carcinomas were particularly resistant to primary chemotherapy. We conclude that the response of mammary carcinomas to primary chemotherapy can at least partially be explained by the tumour differentiation and is therefore to some extent predictable with careful evaluation of the pretreatment punch biopsy. The semiquantitative histological evaluation score suggested in this article permits the classification of the treatment effects and is therefore useful for further therapy planning.