摘要
目的探索初始腋窝淋巴结转移(cN+)乳腺癌新辅助治疗(NAT)后腋窝病理完全缓解(apCR)的临床病理预测因素。方法回顾性分析四川省肿瘤医院乳腺科2016年6月至2023年4月经治的cN+且接受NAT的乳腺癌病例。根据术后病理结果,分为apCR组及非apCR组,比较两组临床病理特点的差异,探索apCR的预测因素。结果共计486例患者纳入本研究,总体apCR率为50.4%(245/486)。单因素分析显示,组织学分级、雌激素受体状态、孕激素受体状态、人类表皮生长因子受体2(HER2)状态、Ki67、临床疗效评价及是否达到乳房病理完全缓解(bpCR)与apCR具有相关性(P均<0.05)。多因素分析表明,HER2阳性(P<0.001)、临床疗效评价较佳(P=0.047)及bpCR(P<0.001)是apCR的独立预测因素。建立的apCR预测模型受试者工作特征(ROC)曲线下面积(AUC)为0.793(95%CI:0.753~0.833),敏感度为68.0%,特异度为81.1%。HER2阳性、临床疗效评价为完全缓解或部分缓解且达到bpCR者72例,其apCR率达93.1%(67/72)。HER2阳性、临床疗效评价为完全缓解且达到bpCR者6例,其apCR率为100%(6/6)。结论初始cN+接受NAT的HER2阳性、临床疗效评价较佳或病理疗效达到bpCR的乳腺癌,腋窝残留肿瘤负荷的风险较低,可作为豁免腋窝淋巴结清扫研究的目标人群。
Objective To identify the predictive factors for axillary pathological complete response(apCR)in initially node-positive(cN+)breast cancer patients treated with neoadjuvant treatment(NAT).Methods Data of cN+breast cancer patients treated with NAT at the Breast Department of Sichuan Cancer Hospital from June 2016 to April 2023 were retrospectively reviewed.Clinicopathological characteristics were compared between patients with and without apCR.Univariate and multivariate analyses were conducted for identifying the predictive factors for apCR.Results A total of 486 patients were included and the overall apCR rate was 50.4%(245/486).In the univariate analysis,histological grade,estrogen receptor status,progesterone receptor status,human epidermal growth factor receptor 2 status,Ki-67 index,clinical response,and breast pathological complete response(bpCR)were associated with apCR(P<0.05).Multivariate analysis demonstrated that HER2 positivity(P<0.001),better clinical response,(P=0.047),and bpCR(P<0.001)were independent predictors of apCR.The area under the receiver operating characteristic curve of the prediction model of apCR in cN+breast cancer patients treated with NAT was 0.793(95%confidence interval:0.753-0.833),with a sensitivity of 68.0%and specificity of 81.1%.Conclusion In cN+breast cancer patients treated with NAT,those with HER2 positive disease,better clinical response,or bpCR have a lower risk of axillary residual disease,and can be candidates for de-escalating surgical research.
作者
牟鳄贤
李卓璇
董浩
于淼
纪娟
徐佳
王浩
刘世伟
Mou Exian;Li Zhuoxuan;Dong Hao;Yu Miao;Ji Juan;Xu Jia;Wang Hao;Liu Shiwei(Department of Breast,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China;Department of Pathology,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China;Department of Plastic and Reconstructive Surgery,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2023年第10期1027-1032,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
四川省科技计划资助(2023YFS0103)
四川省自然科学基金资助(2022NSFSC0707)
四川省抗癌协会2022年(齐鲁)科研专项资金资助(XH2022515)
四川省干部保健科研课题(川干研2021-802)
关键词
乳腺癌
腋窝淋巴结转移
新辅助治疗
腋窝病理完全缓解
预测因素
Breast cancer
Axillary lymph node metastasis
Neoadjuvant treatment
Axillary pathological complete response
Predictive factor
