Introdução: A quimioterapia neoadjuvante é aquela realizada antes do tratamento cirúrgico e tem como finalidade tornar operável um tumor localmente avançado, proporcionar tratamento conservador a pacientes inicialmente candidatas à mastectomia, demonstrar a sensibilidade in vivo e avaliar a resposta patológica ao tratamento instituído. A resposta patológica é considerada fator prognóstico e diversos estudos demonstram correlação entre os fatores biológicos do tumor e a taxa de resposta. Pacientes que apresentam resposta patológica completa (RPC) têm maior sobrevida em comparação àquelas com doença residual na mama ou na axila. Objetivo: O objetivo principal foi avaliar a RPC em pacientes com câncer de mama submetidas à quimioterapia neoadjuvante. Como objetivos secundários, identificamos as variáveis clínico-patológicas relacionadas à RPC e correlacionamos a resposta patológica na mama com a resposta axilar pós-quimioterapia. Material e Métodos: Neste estudo, foram revisados 444 prontuários de pacientes atendidas no setor de Mastologia, entre janeiro de 2016 e julho de 2019. Oitenta e três pacientes com diagnóstico de carcinoma invasivo foram selecionadas, sendo excluídos 361 casos, conforme os critérios de exclusão (doença benigna, hormonioterapia e radioterapia neoadjuvantes, trastuzumabe associado à quimioterapia, cirurgia upfront e pacientes que não receberam tratamento cirúrgico após a quimioterapia). As variáveis analisadas foram: idade, tamanho do tumor, acometimento axilar, tipo e grau histológico, subtipo molecular e RPC. Resultados e Conclusão: A maioria das pacientes tinha mais de 50 anos (62%) e tumores maiores que 5 cm (75%). Cinquenta pacientes (60%) apresentavam acometimento axilar inicial. Das 83 pacientes, 64 (77%) não obtiveram resposta patológica na mama e na axila. Duas mulheres (3%) apresentaram resposta somente na mama. A RPC foi observada em 17 pacientes (20%), e quase metade destas tinha menos de 50 anos (47%). Os tumores moderadamente diferenciados (grau 2) e indiferenciados (grau 3) somavam 96% dos casos e tiveram maior taxa de RPC que os tumores grau 1 (não obtida em nenhuma paciente). Nos subtipos HER2 positivos, a RPC ocorreu em 36% dos casos e nos triplos negativos em 22%, sendo maior que nos subtipos luminais A e B (15 e 17%, respectivamente). O grau histológico e os subtipos moleculares apresentaram correlação com RPC à quimioterapia neoadjuvante. Tumores mais indiferenciados e os subtipos moleculares triplo negativo e HER 2 positivo apresentaram maior taxa de RPC. Apesar da pequena casuística, os resultados deste estudo foram semelhantes aos da literatura médica sobre RPC pós-quimioterapia neoadjuvante. Um maior número de casos se faz necessário para corroborar os dados obtidos, assim como um tempo de seguimento maior para demonstrar a relação entre RPC e sobrevida.
Introduction: Neoadjuvant chemotherapy is performed before surgical treatment and aims to make a locally advanced tumor operable, provide conservative treatment, demonstrate tumor sensitivity in vivo and evaluate the pathological response (PR) to treatment. PR is an important prognostic factor, and several studies have demonstrated a correlation between the biological factors of the tumor and its response rate. Patients with a pathologic complete response (PCR) present a longer survival rate compared to those with residual disease. Objectives: The main objective was to assess PCR in patients with breast cancer undergoing neoadjuvant chemotherapy. As secondary objectives, we identified clinical-pathological variables related to PCR and correlated the pathologic response in the breast with the axillary response after chemotherapy. Methods: Four hundred and forty-four medical records of patients seen in the Mastology sector were reviewed between January 2016 and July 2019. Eighty-three patients were selected, with 361 cases that did not meet the inclusion criteria being excluded. The exclusion criteria were benign disease, neoadjuvant hormone therapy, neoadjuvant radiation therapy, trastuzumab associated with chemotherapy, upfront surgery and patients who did not receive surgical treatment after chemotherapy. The variables analyzed were age, tumor size, axillary involvement, histological type and grade, molecular subtype and PCR. Results: Most patients were over 50 years of age (62%) and had tumors larger than 5 cm (75%). Fifty of them (60%) had initial axillary involvement. Among the 83 patients, 64 (77%) did not obtain a pathologic response in the breast and armpit. Two (3%) showed a response only in the breast. PCR was observed in 17 patients (20%) and almost half of them were under 50 years of age (47%). Moderately differentiated (grade 2) and undifferentiated (grade 3) tumors, accounted for 96% of cases and had a higher rate ofPCR than grade 1 tumors. In HER2 positive subtypes, PCR occurred in 36% and in negative triples in 22%, being higher than in luminous A and B subtypes (15% and 17%, respectively). Conclusions: The histological grade and molecular subtypes correlate with the pathologic response to neoadjuvant chemotherapy. More undifferentiated tumors and the triple negative and HER 2 positive molecular subtypes have a higher PCR rate. Despite the small sample, the results of this study were similar to those in the medical literature. A higher number of cases is necessary to corroborate the data obtained, as well as a longer follow-up time to demonstrate the relationship between PCR and survival.
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