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KMID : 0939920160480041363
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대한암학회지
2016 Volume.48 No. 4 p.1363 ~ p.1372
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Locoregional Recurrence by Tumor Biology in Breast Cancer Patients after Preoperative Chemotherapy and Breast Conservation Treatment
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Jwa Eun-Jin
Shin Kyung-Hwan
Kim Ja-Young
Park Young-Hee
Jung So-Youn
Lee Eun-Sook
Park In-Hae
Lee Keun-Seok
Ro Jung-Sil
Kim Yeon-Joo
Kim Tae-Hyun
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Abstract
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Purpose : The purpose of this study is to determine whether breast cancer subtype can affect locoregional recurrence (LRR) and ipsilateral breast tumor recurrence (IBTR) after neoadjuvant chemotherapy (NAC) and breast-conserving therapy (BCT).
Materials and Methods : We evaluated 335 consecutive patients with clinical stage II-III breast cancer who received NAC plus BCT from 2002 to 2009. Patients were classified according to six molecular subtypes: luminal A (hormone receptor [HR]+/HER2?/Ki-67 < 15%, n=113), luminal B1 (HR+/HER2?/Ki-67 ≥ 15%, n=33), luminal B2 (HR+/HER2+, n=83), HER2 with trastuzumab (HER2[T+]) (HR?/HER2+/use of trastuzumab, n=14), HER2 without trastuzumab (HER2[T?]) (HR?/HER2+, n=31), and triple negative (TN) (HR?/HER2?, n=61).
Results : After a median follow-up period of 7.2 years, 26 IBTRs and 37 LRRs occurred. The 5-year LRR-free survival rates were luminal A, 96.4%; B1, 93.9%; B2, 90.3%; HER2(T+), 92.9%; HER2(T?), 78.3%; and TN, 79.6%. The 5-year IBTR-free survival rates were luminal A, 97.2%; B1, 93.9%; B2, 92.8%; HER2(T+), 92.9%; HER2(T?), 89.1%; and TN, 84.6%. In multivariate analysis, HER2(T?) (IBTR: hazard ratio, 4.2; p=0.04 and LRR: hazard ratio, 7.6; p < 0.01) and TN subtypes (IBTR: hazard ratio, 6.9; p=0.01 and LRR: hazard ratio, 8.1; p < 0.01) were associated with higher IBTR and LRR rates. A pathologic complete response (pCR) was found to show correlation with better LRR and a tendency toward improved IBTR controls in TN patients (IBTR, p=0.07; LRR, p=0.03).
Conclusion : The TN and HER2(T?) subtypes predict higher rates of IBTR and LRR after NAC and BCT. A pCR is predictive of improved IBTR or LRR in TN subtype.
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KEYWORD
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Breast neoplasms, Molecular subtype, Neoadjuvant chemotherapy, Ipsilateral breast tumor recurrence, Local neoplasm recurrence
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