Clinical tumor stage is the most important predictor of pathological complete response rate after neoadjuvant chemotherapy in breast cancer patients.
Clinical tumor stage is the most important predictor of pathological complete response rate after neoadjuvant chemotherapy in breast cancer patients.
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DOI：
10.1007/s10549-017-4155-2
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发表时间：
2017-05
影响因子：
3.8
通讯作者：
Smidt ML
中科院分区：
文献类型：
--
作者：
Goorts B;van Nijnatten TJ;de Munck L;Moossdorff M;Heuts EM;de Boer M;Lobbes MB;Smidt ML
病理完全缓解（pCR）是乳腺癌患者接受新辅助化疗（NCT）治疗的最终缓解。它可能是无病生存期（DFS）和总生存期（OS）的替代结局。我们研究了临床肿瘤分期（cT分期）对肿瘤pCR的影响以及每个cT分期的pCR对5年OS和DFS的影响。使用荷兰癌症登记处，确定了2005年至2008年接受NCT治疗的所有原发性浸润性乳腺癌患者。进行单变量logistic回归分析以评估cT分期对pCR的影响，进行逐步logistic回归分析以校正潜在混杂因素，并进行Kaplan-Meier生存分析以计算5年后的OS和DFS。在2366例患者中，总体pCR率为21%。对于cT1、cT2、cT3和cT4，pCR率分别为31%、22%、18%和17%。较低的cT分期（cT1 - 2 vs cT3 - 4）是较高pCR率的显著独立预测因素（p <0.001，OR 3.15）。此外，阳性HER2状态（p <0.001，OR 2.30）、阴性雌激素受体状态（p = 0.062，OR 1.69）和阴性孕激素受体状态（p = 0.008，OR 2.27）是pCR的独立预测因子。具有pCR的cT2 - 4肿瘤患者的OS和DFS比不具有pCR的患者高20%。具有pCR的cT1肿瘤的DFS也更高。乳腺癌患者中pCR的最重要预测因子是cT分期：较低的cT分期比较高的cT分期具有显著较高的pCR率。与未实现pCR的患者相比，实现pCR的cT2 - 4肿瘤患者的OS和DFS更高。
Pathological complete response (pCR) is the ultimate response in breast cancer patients treated with neoadjuvant chemotherapy (NCT). It might be a surrogate outcome for disease-free survival (DFS) and overall survival (OS). We studied the effect of clinical tumor stage (cT-stage) on tumor pCR and the effect of pCR per cT-stage on 5-year OS and DFS. Using the Netherlands Cancer Registry, all primary invasive breast cancer patients treated with NCT from 2005 until 2008 were identified. Univariable logistic regression analysis was performed to evaluate the effect of cT-stage on pCR, stepwise logistic regression analysis to correct for potential confounders and Kaplan–Meier survival analyses to calculate OS and DFS after five years. In 2366 patients, overall pCR rate was 21%. For cT1, cT2, cT3, and cT4, pCR rates were 31, 22, 18, and 17%, respectively. Lower cT-stage (cT1-2 vs cT3-4) was a significant independent predictor of higher pCR rate (p < 0.001, OR 3.15). Furthermore, positive HER2 status (p < 0.001, OR 2.30), negative estrogen receptor status (p = 0.062, OR 1.69), and negative progesterone receptor status (p = 0.008, OR 2.27) were independent predictors of pCR. OS and DFS were up to 20% higher in patients with cT2-4 tumors with pCR versus patients without pCR. DFS was also higher for cT1 tumors with pCR. The most important predictor of pCR in breast cancer patients is cT-stage: lower cT-stages have significantly higher pCR rates than higher cT-stages. Patients with cT2-4 tumors achieving pCR have higher OS and DFS compared to patients not achieving pCR.