2017年5月19日，美国《肿瘤标靶》在线发表宁波市医疗中心李惠利东部医院、复旦大学附属肿瘤医院肿瘤研究所、复旦大学上海医学院的研究报告，调查了紫杉醇＋卡铂＋曲妥珠单抗新辅助治疗后，HER2阳性和腋窝淋巴结阳性乳腺癌患者病理学完全缓解（pCR）的比例以及预测因素。
该研究将连续88例接受紫杉醇＋卡铂＋曲妥珠单抗新辅助治疗的中国HER2阳性、腋窝淋巴结阳性乳腺癌患者分为pCR或无pCR组，比较并分析其临床和病理学特征，进行单变量和多变量分析以检出pCR的预测因素。
结果发现：
乳腺、腋窝和两者的pCR率分别为44.3%（39/88）、47.7%（42/88）和34.1%（30/88）。
有无pCR患者的年龄、体重指数、月经状态、家族史、治疗周期、肿瘤特征（肿瘤的左右侧和大小）相似。
多变量逻辑回归分析表明，pCR与激素受体阴性或Ki67指数高有显著相关性（风险比：5.587、4.130，95%置信区间：2.25～3.889、1.607～10.610，P＜0.001、=0.003）。
进一步调查发现，激素受体阴性且Ki67指数高的患者与其他患者相比，pCR率较高（风险比：7.583，95%置信区间：2.503～22.974，P＜0.001）。
因此，术前紫杉醇＋卡铂＋曲妥珠单抗方案是HER2阳性和腋窝淋巴结阳性患者的有效新辅助疗法，对于激素受体阴性且Ki67指数高的患者可能获益较多。
Oncotarget. 2017 May 19. [Epub ahead of print]
Predictive factors of pathologic complete response in HER2- positive and axillary lymph node positive breast cancer after neoadjuvant paclitaxel, carboplatin plus with trastuzumab.
Ding J, Yang Y, Jiang L, Wu W, Shao Z.
Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, China.
Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, China.
OBJECTIVE: This study was performed to investigate the proportion as well as the predictive factors of pathologic complete response in HER2-positive and axillary lymph node positive breast cancer after neoadjuvant paclitaxel, carboplatin plus with trastuzumab (PCH).
MATERIALS AND METHODS: 88 consecutive Chinese HER2-positive/axillary lymph node-positive breast cancer patients with neodjuvant therapy regimen containing paclitaxel, carboplatin and trastuzumab were divided into two groups: pathological complete response (pCR) or non-pCR group. Clinico-pathological characteristics were compared and analyzed, and univariate and multivariate analyses were performed to detect the predictive factors of pCR.
RESULTS: The pCR rate in the breast, axilla and both was 44.3% (39/88), 47.7% (42/88) and 34.1% (30/88), respectively. Patients with and without pCR were similar in term of age, BMI, menstrual status, family history, treatment cycles and tumor characteristics (laterality and size of tumor). Multivariate logistic regression demonstrated that pCR was significantly associated with HR negativity (HR = 5.587, 95% CI 2.25-3.889, p < 0.001), high Ki67 index (HR = 4.130, 95% CI 1.607-10.610, p = 0.003). Further investigation found that patients with HR-negative/high Ki67 index had higher pCR rate, compared to other patients (HR = 7.583, 95% CI 2.503-22.974, p < 0.001).
CONCLUSIONS: Preoperative PCH regimen was an effective neoadjuvant therapy in HER2 positive and axillary lymph node positive patients, and patients coexisting with HR-negative and high Ki67 index may benefit more from this regimen.
KEYWORDS: Ki67; breast cancer; human epidermal growth factor receptor 2 (HER2); neoadjuvant chemotherapy; pathological complete response (pCR)
PMID: 28611275
DOI: 10.18632/oncotarget.17993
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