新辅助化疗后残余肿瘤负荷:乳腺癌患者重要的预后因素
  • 为确定新辅助化疗后残余肿瘤负担(RCB)与乳腺癌长期生存的关系,文章分析了5个乳腺癌队列的RCB指数与长期生存的相关性;
  • 其中3个队列中患者接受了紫杉醇(T)、氟尿嘧啶、阿霉素和环磷酰胺(T/FAC)化疗方案,另外两个队列中患者分别接受FAC及曲妥珠单抗(H)联合T-FAC化疗方案;
  • 通过检测激素受体(HR)和HER-2的状态将患者分为三个分子亚型;
  • 结果显示:在所有分子亚型中,RCB指数均为新辅助化疗后长期生存的预后因素。
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Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype

新辅助化疗后长期预后风险与残余肿瘤负担和乳腺癌分型相关

10.1200/JCO.2015.63.1010

2017-04-01, Article

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Purpose To determine the long-term prognosis in each phenotypic subset of breast cancer related to residual cancer burden (RCB) after neoadjuvant chemotherapy alone, or with concurrent human epidermal growth factor receptor 2 (HER2)-targeted treatment. Methods We conducted a pathologic review to measure the continuous RCB index (wherein pathologic complete response has RCB = 0; residual disease is categorized into three predefined classes of RCB index [RCB-I, RCB-II, and RCB-III]), and yp-stage of residual disease. Patients were prospectively observed for survival. Three patient cohorts received paclitaxel (T) followed by fluorouracil, doxorubicin, and cyclophosphamide (T/FAC): original development cohort (T/FAC-1), validation cohort (T/FAC-2), and independent validation cohort (T/FAC-3). Another validation cohort received FAC chemotherapy only, and a fifth cohort received concurrent trastuzumab (H) with sequential paclitaxel and fluorouracil, epirubicin, and cyclophosphamide (FEC; H+T/FEC). Phenotypic subsets were defined by hormone receptor (HR) and HER2 status at diagnosis, classified as HR-positive/HER2-negative, HER2-positive (HR-negative/HER2-positive or HR-positive/HER2-positive), or triple receptor-negative. Relapse-free survival estimates were determined from Kaplan-Meier analysis and compared using the log-rank test. Results Five cohorts (T/FAC-1 [n = 219], T/FAC-2 [n = 262], T/FAC-3 [n = 342], FAC [n = 132], and H+T/FEC [n = 203]) had median event-free follow-up of 13.5, 9.1, 6.8, 16.4, and 7.1 years, respectively. Continuous RCB index was prognostic within each phenotypic subset, independent of other clinical-pathologic variables. RCB classes stratified prognostic risk overall, within each phenotypic subset, and within yp-stage categories. Estimates of 10-year relapse-free survival rates in the four RCB classes (pathologic complete response, RCB-I, RCB-II, and RCB-III) were 86%, 81%, 55%, and 23% for triple receptor-negative; 83%, 97%, 74%, and 52% for HR-positive/HER2-negative in the combined T/FAC cohorts; and 95%, 77%, 47%, and 21% in the H+T/FEC cohort. Conclusion RCB was prognostic for long-term survival after neoadjuvant chemotherapy in all three phenotypic subsets of breast cancer. Our institutional findings should be externally validated.

First Authors:
W Fraser Symmans

Correspondence Authors:
W Fraser Symmans

All Authors:
W Fraser Symmans,Caimiao Wei,Rebekah Gould,Xian Yu,Ya Zhang,Mei Liu,Andrew Walls,Alex Bousamra,Maheshwari Ramineni,Bruno Sinn,Kelly Hunt,Thomas A Buchholz,Vicente Valero,Aman U Buzdar,Wei Yang,Abenaa M Brewster,Stacy Moulder,Lajos Pusztai,Christos Hatzis,Gabriel N Hortobagyi

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