The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy.
The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy.
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DOI：
10.1245/s10434-010-1008-1
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发表时间：
2010-09
影响因子：
3.7
通讯作者：
Vrancken Peeters MT
中科院分区：
文献类型：
--
作者：
Straver ME;Rutgers EJ;Rodenhuis S;Linn SC;Loo CE;Wesseling J;Russell NS;Oldenburg HS;Antonini N;Vrancken Peeters MT
乳腺癌越来越被认为是一种异质性疾病。本研究的目的是评估保乳手术和新辅助化疗后病理完全缓解（pCR）的组织学和基于受体的亚型之间的差异。对254例可手术乳腺癌患者连续接受新辅助化疗进行分析。肿瘤根据受体状态分为雌激素受体（ER）阳性肿瘤（her2阴性）、三阴性肿瘤和her2阳性肿瘤。将新辅助化疗前可行的手术类型与实际手术进行比较。保乳手术总体增加了37%（198例中有73例）。在导管癌和小叶癌患者中，这一增加分别为41%（152例中的63例，95%可信区间[95% CI] 0.34-0.49）和20%(35例中的7例，95% CI 0.10-0.36) （P = 0.02）。一半的小叶癌患者由于切除边缘不完全而接受二次乳房切除术。在er阳性、三阴性和her2阳性肿瘤中，保乳手术的增加分别为39% （42 / 109,95% CI 0.30-0.48）、24% （11 / 45,95% CI 0.14-0.38）和45% (20 / 44,95% CI 0.32-0.60) （P = 0.11）。导管癌和小叶癌的pCR率分别为12%（23 / 195）和2% (1 / 42)（P = 0.09）。在er阳性、三阴性和her2阳性肿瘤中，pCR率分别为2%（138例中3例）、28%（57例中16例）和18%（56例中10例）。多因素分析显示，基于受体的亚型是pCR的唯一显著预测因子（P = 0.004）。在小叶肿瘤中，新辅助化疗对保乳手术的益处值得怀疑。虽然在er阳性肿瘤中pCR率较低，但在导管er阳性肿瘤中保乳手术的增加是显著的。
Breast cancer is increasingly considered a heterogeneous disease. The aim of this study was to assess the differences between histological and receptor-based subtypes in breast-conserving surgery and pathological complete response (pCR) after neoadjuvant chemotherapy. A consecutive series of 254 patients with operable breast cancer treated with neoadjuvant chemotherapy was analyzed. Tumors were classified according to their receptor status in estrogen receptor (ER)-positive tumors (HER2-negative), triple-negative tumors, and HER2-positive tumors. The type of surgery feasible prior to neoadjuvant chemotherapy was compared with the actual surgery performed. The overall increase in breast-conserving surgery was 37% (73 of 198). In patients with ductal and lobular carcinomas this increase was 41% (63 of 152, 95% confidence interval [95% CI] 0.34–0.49) and 20% (7 of 35, 95% CI 0.10–0.36), respectively (P = 0.02). Half of the patients with lobular carcinoma had to undergo a secondary mastectomy because of incomplete resection margins. In ER-positive, triple-negative and HER2-positive tumors, the increase in breast-conserving surgery was 39% (42 of 109, 95% CI 0.30–0.48), 24% (11 of 45, 95% CI 0.14–0.38), and 45% (20 of 44, 95% CI 0.32–0.60) (P = 0.11). The pCR rate in ductal and lobular carcinomas was 12% (23 of 195) and 2% (1 of 42), respectively (P = 0.09). In ER-positive, triple-negative and HER2-positive tumors the pCR rates were 2% (3 of 138), 28% (16 of 57), and 18% (10 of 56), respectively. Multivariate analysis showed that the receptor-based subtype was the only significant predictor of pCR (P = 0.004). In lobular tumors the benefit with regard to breast-conserving surgery of neoadjuvant chemotherapy is questionable. Although in ER-positive tumors the pCR rate is low, the increase in breast-conserving surgery was remarkable in ductal ER-positive tumors.
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影响因子：
11.5
作者：
Lebowitz, PF;Eng-Wong, J;Zujewski, J
通讯作者：
Zujewski, J
影响因子：
45.3
作者：
Hannemann, J;Oosterkamp, HM;van de Vijver, MJ
通讯作者：
van de Vijver, MJ
影响因子：
11.5
作者：
Carey, Lisa A.;Dees, E. Claire;Perou, Charles M.
通讯作者：
Perou, Charles M.
影响因子：
45.3
作者：
Mazouni, Chafika;Peintinger, Florentia;Pusztai, Lajos
通讯作者：
Pusztai, Lajos
影响因子：
45.3
作者：
van der Hage, JA;van de Velde, CJH;Duchateau, L
通讯作者：
Duchateau, L