Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2016.57.131
Morphological and pathological response in primary systemic therapy of patients with breast cancer and the prediction of disease free survival: a single center observational study
Gyöngyvér Szentmártoni
; Semmelweis University, Department of Clinical Oncology, Budapest, Hungary
Anna-Mária Tőkés
; 2nd Department of Pathology, Budapest, Hungary
Timea Tőkés
; Semmelweis University, Department of Clinical Oncology, Budapest, Hungary
Krisztián Somlai
; Surgical Division of St. Margit Hospital, Budapest, Hungary
Attila Marcell Szász
; 2nd Department of Pathology, Budapest, Hungary
László Torgyík
; Semmelweis University, Department of Clinical Oncology, Budapest, Hungary
Janina Kulka
; 2nd Department of Pathology, Budapest, Hungary
Magdolna Dank
orcid.org/0000-0002-4442-8733
; Semmelweis University, Department of Clinical Oncology, Budapest, Hungary
Sažetak
Aim To identify breast cancer subtypes likely to respond
to primary systemic therapy (PST or neoadjuvant therapy)
and to assess the accuracy of physical examination (PE) and
breast ultrasonography (US) in evaluating and predicting residual
size of breast carcinoma following PST.
Methods 116 patients who received at least two cycles of
PST between 1998 and 2009 were selected from a prospectively
collected clinical database. Radiological assessment
was done by mammography and US. Prior to PST, tumors
were subclassified according to core biopsy (NCB) and/or
fine-needle aspiration-based immunohistochemical profiles
of NCB. Pathological response rates were assessed following
the surgeries by using Chevallier classification. Tumor measurements
by PE and US were obtained before and after PST.
Different clinical measurements were compared with histological
findings. Disease-free survival (DFS) was assessed.
Results Pathological complete remission (pCR = Chevallier
I/II) was observed in 25 patients (21.5%), 44% of whom
had triple negative histology, 28% Her2 positive and 76%
had high-grade tumor. Of 116 patients, 24 received taxanebased
PST, 48 combined taxane + anthracycline treatment,
8 trastuzumab combinations, 21 anthracycline-based treatments,
and 15 other treatments. In the taxane treated group,
the pCR rate was 30%, in the taxane + anthracycline group
25%, in the anthracycline group 9.5%, and in trastuzumab
group 37.5%. After PST, PE and US were both significantly
associated with pathology (P < 0.001 and P = 0.004, respectively).
Concerning OS, significant difference was observed
between the Chevallier III and IV group (P = 0.031) in favor
of Chevallier III group. In the pCR group, fewer events were
observed during the follow-up period.
Conclusions Our results show that even limited, routinely
used immunohistochemical profiling of tumors can predict
the likelihood of pCR to PST: patients with triple negative
and Her2-positive cancers are more likely to achieve pCR to
PST. Also, PE is better correlated with pathological findings
than US.
Ključne riječi
Hrčak ID:
169483
URI
Datum izdavanja:
15.4.2016.
Posjeta: 865 *