摘要
背景与目的:新辅助化疗(neoadjuvant chemotherapy,NAC)目前已成为局部晚期乳腺癌患者的标准治疗模式。探讨人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性和三阴性乳腺癌(triplenegativebreastcancer,TNBC)患者NAC后选择性避免腋窝手术分期的可行性及可能获益人群。方法:回顾性分析2010年1月—2018年8月山东省肿瘤防治研究院(山东省肿瘤医院)收治的865例行NAC患者的临床病理学资料,其中184例(21.3%)为HER2阳性和TNBC患者,分析其临床病理学特征与NAC后腋窝淋巴结病理学阴性(ypN0)的相关性。结果:NAC前肿瘤分期、淋巴结分期及Ki-67,NAC后腋窝淋巴结临床阴性(ycN0)、乳房影像学完全缓解(breast radiologiccompleteresponse,brCR)及乳房病理学完全缓解(breastpathologiccompleteresponse,bpCR)均与NAC后ypN0显著相关(P<0.05),其中NAC前临床淋巴结分期(OR=0.363,P<0.001)、bpCR(OR=11.285,P<0.001)及ycN0(OR=4.995,P<0.001)是NAC后ypN0的独立预测因素。cN0→ycN0组37例,NAC后bpCR、未达bpCR患者ypN0率分别为100.0%(17/17)、90.0%(18/20)(P=0.178)。cN1→ycN0组42例,NAC后bpCR、未达bpCR患者ypN0率分别为95.8%(23/24)、55.6%(10/18)(P<0.001)。NAC后未达bpCR的cN1患者腋窝淋巴结残留转移的相对风险是bpCR患者的10.56倍(95%CI:2.720~41.003;P<0.001)。结论:在HER2阳性和TNBC患者中,NAC后bpCR与腋窝淋巴结状态具有高度相关性。NAC后bpCR的cN0及部分cN1患者(NAC后降期为ycN0)腋窝淋巴结残留转移的风险<5%,使其选择性避免腋窝手术分期成为可能。
Background and purpose:Neoadjuvant chemotherapy(NAC)has become the standard treatment mode for locally advanced breast cancer patients.This study aimed to explore the feasibility of selective elimination of axillary surgery staging after NAC in human epidermal growth factor receptor 2(HER2)positive and triple-negative breast cancer(TNBC)patients,and to assess which patients would acquire greater benefits from it.Methods:From Jan.2010 to Aug.2018,865 patients who underwent surgery after NAC in Shandong Cancer Hospital and Institute were included in this retrospective study to analyze the correlation between clinicopathological characteristics of HER2 positive and TNBC patients and pathologically negative axillary lymph nodes after NAC(ypN0).Results:Among the 184(21.3%)HER2 positive and TNBC patients receiving NAC,tumor staging,lymph node staging and Ki-67 before NAC,clinically node-negative(ycN0),breast radiologic complete response(brCR)and breast pathologic complete response(bpCR)after NAC were correlated with ypN0(P<0.05).Clinical lymph node staging before NAC(OR=0.363,P<0.001),bpCR(OR=11.285,P<0.001)and ycN0(OR=4.995,P<0.001)were the independent predictors of ypN0.Among 37 patients with clinically nodal-negative breast cancer before(cN0)and after(ycN0)NAC,17 of 17(100.0%)with and 18 of 20(90.0%)without a bpCR had no evidence of residual nodal disease(P=0.178).Among 42 patients with cN1 to ycN0,23 of 24(95.8%)with and 10 of 18(55.6%)without a bpCR had no evidence of residual nodal disease(P<0.001).Patients without a bpCR had a relative risk for nodal residual metastases of 10.56(95%CI:2.720-41.003;P<0.001)compared with those with a bpCR in cN1 group.Conclusion:In HER2 positive and TNBC patients,bpCR is highly correlated with nodal status after NAC.The risk of axillary lymph nodes residual metastases after NAC in the patients of bpCR with cN0 and cN1 to ycN0 was less than 5%,making it possible to selectively eliminate axillary surgery staging.
作者
石志强
邱鹏飞
刘雁冰
赵桐
孙晓
陈鹏
王春建
张朝蓬
丛斌斌
王永胜
SHI Zhiqiang;QIU Pengfei;LIU Yanbing;ZHAO Tong;SUN Xiao;CHEN Peng;WANG Chunjian;ZHANG Zhaopeng;CONG Binbin;WANG Yongsheng(Breast Cancer Center,Shandong Cancer Hospital and Institute,Jinan 250117,Shandong Province,China;Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250062,Shandong Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2020年第3期186-191,共6页
China Oncology
基金
国家自然科学基金(81502314)
山东省医药卫生科技发展计划项目(2016WS0549)。
关键词
乳腺癌
新辅助化疗
三阴性乳腺癌
人表皮生长因子受体2阳性
腋窝手术分期
Breast cancer
Neoadjuvant chemotherapy
Triple-negative breast cancer
Human epidermal growth factor receptor 2 positive
Axillary surgery staging
