毕钊, 丛斌斌, 刘静静, 陈鹏, 刘雁冰, 邱鹏飞, 邱恒, 徐乘骏, 王永胜. 分子分型与乳腺癌新辅助化疗腋窝降阶梯手术的研究[J]. 中国肿瘤临床, 2018, 45(8): 390-393. DOI: 10.3969/j.issn.1000-8179.2018.08.091
引用本文: 毕钊, 丛斌斌, 刘静静, 陈鹏, 刘雁冰, 邱鹏飞, 邱恒, 徐乘骏, 王永胜. 分子分型与乳腺癌新辅助化疗腋窝降阶梯手术的研究[J]. 中国肿瘤临床, 2018, 45(8): 390-393. DOI: 10.3969/j.issn.1000-8179.2018.08.091
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Bi Zhao, Cong Binbin, Liu Jingjing, Chen Peng, Liu Yanbing, Qiu Pengfei, Qiu Heng, Xu Chengjun, Wang Yongsheng. Molecular subtypes and axillary downstaging surgery after neoadjuvant chemotherapy for breast cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(8): 390-393. DOI: 10.3969/j.issn.1000-8179.2018.08.091
Citation: Bi Zhao, Cong Binbin, Liu Jingjing, Chen Peng, Liu Yanbing, Qiu Pengfei, Qiu Heng, Xu Chengjun, Wang Yongsheng. Molecular subtypes and axillary downstaging surgery after neoadjuvant chemotherapy for breast cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(8): 390-393. DOI: 10.3969/j.issn.1000-8179.2018.08.091
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分子分型与乳腺癌新辅助化疗腋窝降阶梯手术的研究

Molecular subtypes and axillary downstaging surgery after neoadjuvant chemotherapy for breast cancer

    摘要
  • 摘要:
      目的  探讨临床淋巴结阴性患者新辅助化疗（neoadjuvant chemotherapeutic，NAC）与前哨淋巴结活检（sentinel lymph node biopsy，SLNB）的最佳时机，评估临床淋巴结阳性患者行NAC后腋窝降阶梯手术可能获益人群。
      方法  回顾性分析2010年10月至2017年11月山东大学附属山东省肿瘤医院收治206例行NAC患者的临床病理资料，分析分子分型与腋窝淋巴结病理完全缓解（axillary nodal pathologic complete response，apCR）的关系。
      结果  206例行NAC患者中183例为临床淋巴结阳性，apCR为33.3%（61/183）。Luminal型HER-2阴性患者apCR为19.8%（17/86），与HER-2阳性行靶向治疗患者apCR的62.1%（18/29）、HER-2阳性未行靶向治疗的34.5%（10/29）及三阴性乳腺癌（triple-negative breast cancer，TNBC）的41.0%（16/39）相比显著降低，差异具有统计学意义（P < 0.001）。23例临床淋巴结阴性患者行NAC后前哨淋巴结阳性率为26.1%（6/23），Luminal型HER-2阴性、TNBC和HER-2阳性患者前哨淋巴结阳性率分别为36.4%（4/11）、25.0%（1/4）和12.5%（1/8）。
      结论  分子分型与行NAC后的apCR相关。对临床淋巴结阴性的Luminal型HER-2阴性患者，NAC前行SLNB可避免腋窝淋巴结清扫，对临床淋巴结阴性的TNBC和HER-2阳性患者，建议NAC后行SLNB。临床淋巴结阳性且行NAC降期转阴的TNBC和HER-2阳性患者，从NAC后的腋窝降阶梯手术中可能获益更多。

     

    Abstract:
      Objective  To determine the optimal time to perform sentinel lymph node biopsy (SLNB) in patients with clinically nodenegative disease and assess clinically node-positive patients who would acquire greater benefits from axillary downstaging surgery after neoadjuvant chemotherapy (NAC).
      Methods  From October 2010 to November 2017, 206 patients with breast cancer who underwent surgery after NAC were included in this retrospective study in Shandong Cancer Hospital Breast Cancer Center. Their clinicopathologic data were collected to discuss the correlation between axillary node pathologic complete response (apCR) and different molecular subtypes.
      Results  Among 206 patients who received NAC, 183 patients had clinically node-positive disease. The frequency of apCR after NAC was 33.3% (61/183), which was significantly higher in patients with human epidermal growth factor receptor 2 (HER-2)-positive subtype with targeted therapy, 62.1% (18/29); without targeted therapy, 34.5% (10/29) and triple-negative breast cancer (TNBC) (41.0%) (16/39) than in patients with HER-2-negative luminal subtype breast cancer 19.8%(17/86)(P < 0.001). Among 23 patients with cN0 tumors, the rate of positive sentinel lymph nodes after NAC was 26.1% (6/23); this rate was 36.4% (4/11), 25.0% (1/4), and 12.5% (1/8) among patients with HER-2-negative luminal subtype breast cancer, TNBC, and HER-2-positive subtype breast cancer, respectively.
      Conclusions  Molecular subtypes could predict the chance of achieving apCR. For patients with clinically node-negative disease, it would be preferable to perform SLNB prior to NAC for patients with HER-2-negative luminal subtype breast cancer. SLNB after NAC for those with TNBC and HER-2-positive subtype breast cancer could decrease the chances of axillary lymph node dissection. For patients with initial clinically node-positive disease converting to clinically node-negative disease after NAC, especially in TNBC and HER-2-positive subtype breast cancer, these patients might benefit more from axillary downstaging surgery after NAC.

     

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