Neoadjuvan Kemoterapi Alan Luminal Tip Meme Kanserli Hastalarda Patolojik Tam Yanıtı Predikte Eden Faktörler

Year 2023, , 269 - 276, 12.06.2023

Zuhat Urakçı Nadiye Akdeniz Sezai Tunç Zeynep Oruç Mehmet Küçüköner Muhammet Ali Kaplan Hüseyin Büyükbayram Abdurrahman Işıkdoğan

https://doi.org/10.5798/dicletip.1313421

Abstract

Amaç: Luminal tip meme kanserinde birçok çalışma yapılmış olmasına rağmen günümüzde bu tip meme kanserinde patolojik tam yanıtı (pCR) predikte eden faktörler halen net olarak bilinmemektedir. Bu çalışmamızda neoadjuvan kemoterapi alan luminal tip meme kanserli hastalarda patolojik tam yanıtı predikte eden faktörleri incelemeyi amaçladık.
Yöntemler: Çalışmaya Ocak 2010 ile Aralık 2018 arasında onkoloji merkezimizde neoadjuvan kemoterapi alan, luminal tip lokal ve lokal ileri evre meme kanserli, 18 yaşından büyük, 122 kadın hasta dahil edildi. Çalışmamızda neoadjuvan kemoterapi alan luminal tip meme kanseri tanılı hastalarda patolojik tam yanıtı predikte etme potansiyeli olan faktörleri retrospektif olarak inceledik.
Bulgular: Hastaların menopozal durumu (p=0.638), tümör lokalizasyonu (sağ-sol) (p=0.791) ve tümör boyutu (p=0.861) ile pCR arasında istatistiksel olarak anlamlı ilişki izlenmedi. Patolojik tam yanıt ile invaziv duktal karsinom histolojisine sahip olma (p=0.001), östrojen reseptör (ER) negatifliği (p=0.034), insan epidermal büyüme faktörü reseptör-2 pozitifliği (HER2) (p=0.030) ve nod negatifliği (p=0.023) arasında istatistiksel olarak anlamlı ilişki saptandı. Patolojik tam yanıt ile hastalığın evresi (II-III) (p=0.051) ve Ki-67 düzeyi (<%20/ ≥%20) (p=0.060) arasında sınırda istatistiksel anlamlılık mevcuttu.
Regresyon analizinde, diğer potansiyel prognostik faktörler ile birlikte değerlendirildiğinde, nod negatifliği ve ER negatifliği pCR’ı predikte eden bağımsız faktörler olarak saptandı (p=0.008, p=0.040, sırası ile). Patolojik tam yanıt elde edilen hasta grubuyla pCR sağlanamayan grup arasında hem hastalıksız sağkalım (DFS) hem de genel sağkalım (OS) açısından farklılık izlenmedi (p=0.315, p=0.576 sırası ile).
Sonuç: Çalışmamızda ER negatifliği ve nod negatifliği pCR’ı predikte eden bağımsız faktörler olarak saptandı. Ki-67’nin %20 üzerinde olması pCR açısından sınırda anlamlılık göstermekteydi. Luminal tip meme kanserli hasta grubunda patolojik tam yanıt prognostik bir faktör olarak saptanmadı.

Keywords

Luminal tip meme kanseri, neoadjuvan kemoterapi, patolojik tam yanıt

References

• 1.Siegel RL, Miller KD. Cancer statistics. CA: A Cancer J.Clin. 2020; 70(1): 7–30.
• 2.Cortazar P, Zhang L, Untch M, et al. Pathologicalcomplete response and long-term clinical benefit inbreast cancer: the CTNeoBC pooled analysis. Lancet.2014; 384(9938): 164–72.
• 3.Kim HS, Yoo TK, Park WC, Chae BJ. Potential Benefitsof Neoadjuvant Chemotherapy in Clinically Node-Positive Luminal Subtype Breast Cancer. J BreastCancer. 2019; 22(3): 412–24.
• 4.Goldhirsch A, Wood WC, Coates AS, et al. Strategiesfor subtypes— dealing with the diversity of breastcancer: highlights of the St Gallen International ExpertConsensus on the Primary Therapy of Early BreastCancer 2011. Ann Oncol. 2011; 22(8): 1736–47.
• 5.von Minckwitz G, Untch M, Blohmer JU, et al.Definition and impact of pathologic complete responseon prognosis after neoadjuvant chemotherapy invarious intrinsic breast cancer subtypes. J Clin Oncol.2012; 30: 1796-804.
• 6.Alba E, Calvo L, Albanell J, et al. Chemotherapy (CT)and hormonotherapy (HT) as neoadjuvant treatment in luminal breast cancer patients: results from theGEICAM/2006-03, a multicenter, randomized, phase-IIstudy. Ann Oncol. 2012; 23: 3069-74.
• 7.Schott AF, Hayes DF. Defining the benefits ofneoadjuvant chemotherapy for breast cancer. J ClinOncol. 2012; 30(15): 1747-9.
• 8.National Comprehensive Cancer Network (NCCN).NCCN Clinical Practice Guidelines in Oncology: BreastCancer. Version 3. 2023.
• 9.Kaufmann M, von Minckwitz G, Bear HD, et al.Recommendations from an international expert panelon the use of neoadjuvant (primary) systemictreatment of operable breast cancer: new perspectives2006. Ann Oncol. 2007; 18: 1927–34.
• 10.Mamounas EP. Neoadjuvant chemotherapy inoperable breast cancer. Breast Care. 2006; 1: 348–51.
• 11.Koolen BB, Valde´s Olmos RA, Wesseling J, et al.Early Assessment of Axillary Response with 18F-FDGPET/CT during Neoadjuvant Chemotherapy in Stage II–III Breast Cancer: Implications for SurgicalManagement of the Axilla. Ann Surg Oncol. 2013;20(7): 2227–35.
• 12.Liu C, Jiang Y, Gu X, et al. Predicting level 2 axillarylymph node metastasis in a Chinese breast cancerpopulation post-neoadjuvant chemotherapy:Development and assessment of a new predictivenomogram. Oncotarget. 2017; 8(45): 79147–56.
• 13.Del Prete S, Caraglia M, Luce A, et al. Clinical andpathological factors predictive of response toneoadjuvant chemotherapy in breast cancer: a singlecenter experience. Oncol Lett. 2019; 18(4): 3873–79.
• 14.Reddy Kunnuru SK, Thiyagarajan M, Daniel JM,Balaji Singh K. A Study on Clinical and PathologicalResponses to Neoadjuvant Chemotherapy in BreastCarcinoma. Breast Cancer (Dove Med Press). 2020; 12:259-66.
• 15.Resende U, Cabello C, Ramalho SOB, Zeferino LC.Prognostic assessment of breast carcinoma submittedto neoadjuvant chemotherapy with pathological non-complete response. BMC Cancer. 2019; 19: 601.
• 16.Penault–Llorca F, Cayre A, Bouchet MF, et al.Induction chemotherapy for breast carcinoma:predictive markers and relation with outcome. Int JOncol. 2003; 22: 1319–25.
• 17.Beresford MJ, Stott D, Makris A. Assessment ofclinical response after two cycles of primarychemotherapy in breast cancer. Breast Cancer ResTreat. 2008; 109: 5.
• 18.Petit T,Wilt M, Velten M, et al. Comparative valueof tumour grade, hormonal receptors, Ki-67, HER-2 and topoisomerase II alpha status as predictive markers inbreast cancer patients treated with neoadjuvantanthracycline-based chemotherapy. Eur J Cancer.2004; 40: 205–11.
• 19.Denkert C, Loibl S, Müller BM, et al. Ki-67 levels aspredictive and prognostic parameters inpretherapeutic breast cancer core biopsies: atranslational investigation in the neoadjuvant Gepar-Trio trial. Ann Oncol. 2013; 24(11): 2786–93.
• 20.Kim KI, Lee KH, Kim TR, Chun YS, Lee TH, Park HK.Ki-67 as a predictor of response to neoadjuvantchemotherapy in breast cancer patients. J BreastCancer. 2014; 17: 40-6.
• 21.Caudle AS, Yu TK, Tucker SL, et al. Local-regionalcontrol according to surrogate markers of breastcancer subtypes and response to neoadjuvantchemotherapy in breast cancer patients undergoingbreast conserving therapy. Breast Cancer Res. 2012;14: R83.
• 22.Tan MC, Al Mushawah F, Gao F, et al. Predictors ofcomplete pathological response after neoadjuvantsystemic therapy for breast cancer. Am J Surg. 2009;198: 520-25.
• 23.Phung HT, Nguyen HT, Van Nguyen T, Van NguyenT, Thi Dinh LA, Van Nguyen C. Pathological completeresponse with neoadjuvant trastuzumab combinedwith Chemotherapy in HER2 positive breast cancer: asingle institution retrospective analysis from vietnam.Breast Cancer. 2020; 12: 117–22.
• 24.Swain SM, Ewer MS, Viale G, et al. Pertuzumab,trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment ofpatients with HER2-positive localized breast cancer(BERENICE): a phase II, open-label, multicenter,multinational cardiac safety study. Ann Oncol. 2018;29(3): 646-53.
• 25.Lee H, Lee DE, Park S, et al. Predicting Response toNeoadjuvant Chemotherapy in Patients With BreastCancer: Combined Statistical Modeling UsingClinicopathological Factors and FDG PET/CT TextureParameters. Clin Nucl Med. 2019; 44(1): 21-9.
• 26.Li Y, Zhang J, Wang B, Zhang H, He J, Wang K. Anomogram based on clinicopathological features andserological indicators predicting breast pathologiccomplete response of neoadjuvant chemotherapy inbreast cancer. Sci Rep. 2021; 11(1): 11348.
• 27.Ferreira R, Kneubil MC, Brollo J, et al. Evaluation ofclinical and pathological response factors toneoadjuvant chemotherapy in breast cancer patients.Mastology. 2021; 31: 1-9.
• 28.Shohdy KS, Almeldin DS, Fekry MA, et al.Pathological responses and survival outcomes inpatients with locally advanced breast cancer afterneoadjuvant chemotherapy: a single-instituteexperience. Journal of the Egyptian National CancerInstitute. 2021; 33(1): 39.
• 29.Fisher B, Bryant J, Wolmark N, et al. Effect ofpreoperative chemotherapy on the outcome ofwomen with operable breast cancer. J Clin Oncol.1998; 16: 2672–85.