病理完整反应的预测因素及其在早期乳腺癌的预后价值:现实世界队列研究
Selami Bayram1, Ali Murat Tatli1, Muharrem Okan Cakir2
1Department of Medical Oncology, Memorial Antalya Hospital, 07025 Antalya, Türkiye.
Current oncology (Toronto, Ont.)
|November 26, 2025
概括
在早期乳腺癌 (EBC) 中,在新辅助全身疗法 (NAST) 后实现病理完整反应 (pCR) 与更好的无病生存率 (DFS) 有关. 预测因素包括HER2阳性,高Ki-67,低ER表达和放射性反应.
科学领域:
- 在瘤学瘤学.
- 乳腺癌研究研究 乳腺癌研究
- 临床试验分析
背景情况:
- 在新辅助全身疗法 (NAST) 后的病理完整反应 (pCR) 是早期乳腺癌 (EBC) 的关键预后指标,特别是在三阴性 (TNBC) 和HER2阳性亚型中.
- 有限的现实世界数据存在于PCR的预测因素及其对患者生存结果的后续影响.
研究的目的:
- 确定与NAST治疗的II-III期EBC患者中实现pCR的独立预测因子.
- 评估pCR与长期生存结果之间的关联,特别是无病生存率 (DFS) 和整体生存率 (OS).
主要方法:
- 在2015年至2023年期间,对200名II-III期EBC患者进行了以NAST治疗的回顾性分析.
- 临床病理学和治疗变量被评估与pCR的关联 (ypT0/is ypN0).
- 用米勒-佩恩评分系统评估组织学回归;采用多变量后勤回归和卡普兰-梅尔方法.
主要成果:
- 总体PCR率为36.0%,在HER2阳性 (65%) 和TNBC (56%) 亚型中比率更高.
- 独立的pCR预测因素包括HER2阳性,高Ki-67 (>47.5%),低ER表达 (<10%),和放射性完整反应.
- 实现pCR的患者显示5年DFS显著改善 (91.5%对72.8%),但没有统计学上显著的OS (92.2%对87.0%).
结论:
- HER2阳性,高Ki-67,低ER表达和放射性完整反应是PCR的关键独立预测因素.
- 获得pCR与改善的DFS有很强的相关性,加强其作为TNBC和HER2阳性EBC的替代终点的作用.
- 这些发现表明,对于无法实现pCR的患者,需要采取治疗升级策略,以改善整体存活率.
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