年轻女性乳腺癌新辅助化疗后的病理学完全缓解与长期结局

　　年轻女性乳腺癌通常具有侵袭性肿瘤生物学特征和较高的复发风险。新辅助治疗后的病理学完全缓解，已被证明是无病生存和总生存的替代标志，但是乳腺癌年轻女性的病理学完全缓解与生存结局之间的相关性尚不明确。

　　2017年10月1日，美国《国家综合癌症网络杂志》发表哈佛医学院、麻省总医院、杜克大学、斯坦福大学的研究报告，分析了年轻女性乳腺癌新辅助化疗后的病理学完全缓解与长期结局的相关性。

　　该本研究入组1998～2014年在麻省总医院接受新辅助化疗的170例II～III期浸润性乳腺癌年轻（诊断时年龄≤40岁）女性，对获得病理学完全缓解（ypT0/is，ypN0）患者和未获病理学完全缓解（残留病变）患者的结局进行比较。

　　结果发现，新辅助化疗后的病理学完全缓解率为31.2%（53例）。

　　病理学完全缓解与否的患者相比：

• 无病生存率分别为91%、60%（P<0.01）

• 总体生存率分别为95%、75%（P<0.01）

　　初始临床分期III期与II期相比：

• 对于获得病理学完全缓解患者，总体生存率相似（P=0.6）

• 对于未获病理学完全缓解患者，总体生存率较低（P=0.0002）

　　因此，该研究结果表明，新辅助化疗后的病理学完全缓解，与乳腺癌年轻女性的无病生存和总体生存显著改善存在高度相关性，甚至可能高于初始临床分期。

　　不过，对于未获病理学完全缓解患者，死亡率显著较高，强调了更佳疗法的必要性，新辅助研究设计可能成为治疗增减和快速分类的有效方法，以改善乳腺癌年轻女性的结局。

J Natl Compr Canc Netw. 2017 Oct 1;15(10):1216-1223.

Pathologic Complete Response After Neoadjuvant Chemotherapy and Long-Term Outcomes Among Young Women With Breast Cancer.

Laura Spring, Rachel Greenup, Andrzej Niemierko, Lidia Schapira, Stephanie Haddad, Rachel Jimenez, Suzanne Coopey, Alphonse Taghian, Kevin S. Hughes, Steven J. Isakoff, Leif W. Ellisen, Barbara L. Smith, Michelle Specht, Beverly Moy, Aditya Bardia.

Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Duke University, Durham, North Carolina; Stanford University, Palo Alto, California.

PURPOSE: Breast cancer in young women is associated with an aggressive tumor biology and higher risk of recurrence. Pathologic complete response (pCR) after neoadjuvant therapy has been shown to be a surrogate marker for disease-free survival (DFS) and overall survival (OS), but the association between pCR and survival outcomes in young women with breast cancer is not well described.

METHODS: This study included women aged ≤40 years at diagnosis who received neoadjuvant chemotherapy (NAC) for stage II–III invasive breast cancer between 1998 and 2014 at Massachusetts General Hospital. Outcomes were compared between patients who achieved pCR (ypT0/is, ypN0) and those with residual disease.

RESULTS: A total of 170 young women were included in the analytical data set, of which 53 (31.2%) achieved pCR after NAC. The 5-year DFS rate for patients with and without pCR was 91% versus 60%, respectively (P<.01), and the OS rate was 95% versus 75%, respectively (P<.01). Among patients with pCR, no difference was seen in OS irrespective of baseline clinical stage (P=.6), but among patients with residual disease after NAC, a significant difference in OS based on baseline clinical stage was observed (P<.001).

CONCLUSIONS: Our results suggest pCR after NAC is strongly associated with significantly improved DFS and OS in young women with breast cancer, and perhaps even more so than baseline stage. However, the significantly higher mortality for patients who did not attain pCR highlights the need for better therapies, and the neoadjuvant trial design could potentially serve as an efficient method for rapid triage and escalation/de-escalation of therapies to improve outcomes for young women with breast cancer.

DOI: 10.6004/jnccn.2017.0158