Pathobiology of preoperative chemotherapy

摘要: BACKGROUND Examination was performed on pathologic material from patients enrolled in the National Surgical Adjuvant Breast Project (NSABP) protocol B-18, which clinical effects of preoperative (preop) and postoperative (postop) doxorubicin cyclophosphamide (AC) were compared. METHODS Of total number 1523 patients, 1234 (81%) pathologically evaluable cohort. Six hundred twenty-six had been randomized prospectively to receive AC postop 608 preop. Preentry diagnosis made by fine-needle aspiration (FNA) and/or Tru-cut biopsy (TC). AC-induced other changes identified, their relation response overall survival (OS) disease-free (DFS) determined. Frequencies lymph node metastases, size, stromal reaction, extracapsular extension (ECE) compared two treatment groups, as correlation with OS DFS. Survival estimates based 9 years follow-up. RESULTS Approximately 13% primary breast carcinoma cases exhibited both a complete (cCR) (absence invasive tumor [pCR]) preop AC. An additional 7% pCR absence cCR. A occurred 38% those determined have achieved Poor nuclear grade cells pre-entry FNA TC specimens significantly predicted pCR. Patients latter better DFS partial (presence sparse [pPR]) or no (pNR). Epithelial alterations considered be induced tumors comprised types 1 2 giant meganuclei, apocrine metaplasia, cytoplasmic vacuolation. They high degree specificity (range, 86–99%) but low sensitivity 7–38%). All predictive pPR found related adversely fibrous reaction noted putative sites group only modest degrees (63%) (74%). Moderate/marked sclerosis basement membranes ductal ductular elements terminal ductolobular unit (TDLU) more frequent nontumor-bearing areas breasts (67% vs. 48%; P < 0.0001). The change TDLU unrelated age. Lymphatic tumor, well positive status, less group. nearly identical being 69% 55% 70% 53% respectively, at years. metastases significant for not OS. ECE similar groups (55% = 0.12). Only 1% axillary failure arms combined. There difference regard parameters whose nodes contained micrometastases (< 2.0 mm) mini 1.0 (the detected immunohistochemically anticytokeratin), true-negative status (not converted positive). Conversely, there apparent treated micrometastases, macrometastases (P 0.19). Those worse 0.0007). remained that negative nodes, although it than 0.02). CONCLUSIONS Poor preentry meganuclear histologic grades also prognostically group, variables No evidence support need radiation metastases. Extended immunohistochemical procedures appear unnecessary detection least when traditional chemotherapy is used. adverse between such small after appears timing administration rather any pathobiologic reasons. Cancer 2002;95:681–95. © 2002 American Society. DOI 10.1002/cncr.10741