Ahmet KAYA, Havva Belma KOÇER, Yeşim AKDENİZ

Triple Negatif Meme Kanseri Hastalarında Neoadjuvan Kemoterapiye Tam Yanıtı Etkileyen Faktörler

AMAÇ: Triple negatif meme kanseri, tüm meme kanseri vakalarının yaklaşık %10-15'ini oluşturan çok agresif bir meme kanseri türüdür. Adjuvan kemoterapi uygulamasına rağmen 5 yıllık hastalıksız sağ kalım oranları diğer tiplere göre daha düşüktür. Tedaviye yanıt hastaların uzun vadeli sonuçlarını gösterebilir. Bazı çalışmalara göre patolojik tam yanıt hastalıksız sağkalım ve genel sağkalım ile ilişkilidir. Neoadjuvan kemoterapi sonrası rezidüel hastalık tümörün tedaviye direncini gösterir. Bu çalışmanın amacı, patolojik tam yanıt ile tümör özellikleri arasındaki ilişkiyi araştırmaktır. GEREÇ VE YÖNTEM: 2015-2022 yılları arasında tek merkezde neoadjuvan kemoterapi sonrası opere edilen 53 triple negatif meme kanseri hastasının verileri retrospektif olarak incelendi. Veriler, SPSS IBM sürüm 25 kullanılarak tanımlayıcı ve çıkarımsal istatistiklerle analiz edildi. BULGULAR: Yaşları 28-81 arasında olan (ortalama: 50,7) 53 hastanın değerlendirilmesinde, hastaların 21'inde (%39,6) patolojik tam yanıt elde edilirken, 32'sinde (%60,4) kısmi yanıt alındığı veya yanıt alınamadığı saptandı. Neoadjuvan kemoterapi öncesi aksiller lenf nodu metastazı olmaması, yüksek Ki-67 proliferasyon indeksi ve metastatik LN'de ekstrakapsüler invazyonun olmaması patolojik tam yanıt ile ilişkili olarak tespit edildirken diğer klinikopatolojik parametrelerin sonuçlara etkisi olmadığı görüldü. TARTIŞMA: Ki-67 proliferasyon indeksi yüksek olan ve aksiller tutulumu olmayan hastaların neoadjuvan kemoterapiden sonra patolojik tam yanıt alma olasılığı daha yüksektir. SONUÇ: Eldeki veriler incelendiğinde Ki-67 proliferasyon indeksi yüksek olan ve koltuk altı lenf nodu tutulumu olmayan hastalarda patolojik tam yanıtın yüksek olması nedeniyle prognozun da daha iyi olabileceği öngörülebilir. ANAHTAR KELİMELER: Tripl negatif meme kanseri, patolojik tam yanıt, neoadjuvan kemoteapi.

Anahtar Kelimeler:

Tripl negatif meme kanseri, patolojik tam yanıt, neoadjuvan kemoteapi.

Factors Affecting Complete Response to Neoadjuvant Chemotherapy in Triple Negative Breast Cancer Patients

AIM: The triple negative breast cancer is a very aggressive type of breast cancer which constituting approximately 10-15% of all cases. Despite the administration of adjuvant chemotherapy, 5-year disease-free survival rates are lower than other types. Response to treatment may indicate patients' long-term outcome. Several studies are associated with pathological complete response , improved disease-free survival and overall survival . Residual disease after neoadjuvant chemotherapy shows the tumor resistance to treatment. The aim of this study is to explore the relationship between pathological complete response and tumor characteristics. MATERIAL AND METHOD: Data of 53 triple negative breast cancer patients who were operated at one center after neoadjuvant chemotherapy between 2015-2022 were retrospectively analyzed. The data analyzed with descriptive and inferential statistics using SPSS IBM version 25. RESULTS: In the evaluation of 53 patients between the ages of 28 and 81 (mean: 50.7), pathological complete response was obtained in 21 of the patients (39.6 %), while 32 (60.4 %) were found to have an incomplete response or no response. Absence of axillary lymph node metastasis before neoadjuvant chemotherapy, high Ki-67 proliferation index and absence of extracapsular invasion in metastatic LN were associated with pathological complete response; Other clinicopathologic parameters were found to have no effect on the results. DISCUSSION: Patients with a high Ki-67 proliferation index and no axillary involvement are more likely to have a pathological complete response after neoadjuvant chemotherapy. CONCLUSION: It can be predicted that the prognosis may be better in patients with high Ki-67 proliferastion index and no axillary involvement .

Keywords:

Triple negative breast cancer, complete pathological response, neoadjuvant chemotherapy,

PDF

___

1. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2017. Toronto, ON. Canada Cancer Society; 2017.
2.Carey LA, Perou CM, Livasy CA, et al. “Race, breast cancer subtypes, and survival in the Carolina breast cancer study,” Journal of the American Medical Association, 2006; 295(21):2492–502.
3. Esserman LJ, Berry DA, DeMichele A, et al. Pathologic complete response predicts recurrence-free survival more effectively by cancer subset: Results from the I-SPY 1 trial CALGB150007/150012, ACRIN 6657. Journal of Clinical Oncology. 2012; 30:3242-49.
4.Liedtke C, Mazouni C, Hess KR, et al., “Response to neoadjuvant therapy and long-term survival in patients with triple negative breast cancer,” Journal of Clinical Oncology. 2008; 26(8):1275–81.
5. Del Prete S, Caraglia M, Luce A, et al. Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in breast cancer: A single center experience. Oncology Letters. 2019; 18:3873-79.
6. Guarneri V, Broglio K, Kau SW, et al. Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. Journal of Clinical Oncology. 2006; 24(7):1037–44.
7. Li XB, Krishnamurti U, Bhattarai S, et al. Biomarkers Predicting Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer. American Journal of Clinical Pathology. 2016; 145(6):871–8.
8. Kennedy RD, Quinn JE, Johnston PG, Harkin DP. BRCA1: mechanisms of inactivation and implications for management of patients. Lancet. 2002; 360 (9338):1007–14.
9. Al-thoubaity FK. Molecular classification of breast cancer: A retrospective cohort study, Annals of Medicine and Surgery. 2019;49:44-8. https://doi.org/ 10.1016/j.amsu.2019.11.021
10. Ogston KN, Miller ID, Payne S, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003; 12: 320–7
11. Amos KD, Adamo B, Anders CK. Triple-Negative Breast Cancer: An Update on Neoadjuvant Clinical Trials. International Journal of Breast Cancer .2012;2012: 385978
12. Lv Y, Li Y, Mu W, et al. Factors Affecting Pathological Complete Response After Neoadjuvant Chemotherapy in Operable Primary Breast Cancer. J Coll Physicians Surg Pak 2020; 30(04):389-93.
13. Yerushalmi R, Woods R, Ravdin PM, et al. Ki67 in breast cancer: prognostic and predictive potential. Lancet Oncology. 2010; 11: 174-83.
14. Denkert C, Budczies J, von Minckwitz G, et al. Strategies for developing Ki-67 as a useful biomarker in breast cancer. Breast. 2015; 24(2): 67-72
15. Ács B, Zámbó V, Vízkeleti L, et al. Ki-67 as a controversial predictive and prognostic marker in breast cancer patients treated with neoadjuvant chemotherapy. Diagnostic Pathology. 2017; 12: 20.
16. Gao JJ, Swain SM. Luminal A Breast Cancer and Molecular Assays: A Review. Oncologist. 2018; 23(5):556-565
17. Haque W, Verma V, Hatch S, et al. Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Research and Treatment .2018; 170:559–567. https://doi.org/10.1007/s10549-018-4801-3
18. Olfatbakhsh A, Tafazzoli-Harandi H, Najafi S, et al. Factors Impacting Pathologic Complete Response after Neoadjuvant Chemotherapy in Breast Cancer: A Single-Center Study, International Journal of Cancer Management. 2018; 11(5):e60098. doi: 10.5812/ijcm.60098.
19. Biswas T, Efird JT, Prasad S, Jindal C, Walker PR. The survival benefit of neoadjuvant chemotherapy and pCR among patients with advanced stage triple negative breast cancer. Oncotarget. 2017; 8:112712-19
20. Gass P, Lux MP, Rauh, C, et al. Prediction of pathological complete response and prognosis in patients with neoadjuvant treatment for triple-negative breast cancer. BMC Cancer. 2018;18; 1051. https://doi.org/10.1186/s12885- 018-4925-1.
21. Jensen SS, Madsen MW, Lukas J, et al. Inhibitory effects of 1α,25-dihydroxyvitamin D(3) on the G(1)-S phase-controlling machinery. Mol Endocrinol. 2001; 15:1370–80.
22. Colston KW, Hansen CM. Mechanisms implicated in the growth regulatory effects of vitamin D in breast cancer. Endocr Relat Cancer. 2002; 9:45–59.
23. Rainville C, Khan Y, Tisman, G. Triple negative breast cancer patients presenting with low serum vitamin D levels: a case series. Cases Journal 2. 2009;8390. https://doi.org/10.4076/1757-1626-2-8390.
24. Kern P, Von Minckwitz G, Puetter C, et al. Prognostic Impact of Residual Disease After Neoadjuvant Chemotherapy in 648 Patients with Triple-negative Breast Cancer. Anticancer Res. 2015; 35: 5479-84