研究表明，MammaPrint®70基因表达谱可以准确预测早期乳腺癌的预后。在167例接受新辅助化疗的II或III期乳腺癌患者中，20%的高风险组患者达到病理完全缓解，而良好预后组的患者无一达到。三阴性肿瘤全部属于高风险组，ER+/HER2-肿瘤中有24%和5%分别属于高风险和低风险组。即使排除三阴性肿瘤，肿瘤的大小缩小程度仍与70基因表达谱结果相关，提示该基因签名可能预测化疗敏感性。长期随访结果显示，高风险组复发率显著高于低风险组。
摘要：
Preoperative (\\#8216;neoadjuvant\\#8217;) chemotherapy is frequently employed in stage II and III breast cancer. A pathological complete remission (pCR) is predictive of a favorable prognosis and is viewed as a surrogate for chemotherapy sensitivity. A pCR, here defined as the complete absence of infiltrating tumor cells at microscopic examination of both the breast and the axilla, is more often achieved in higher grade tumors and it is relatively rare in ER+/HER2- tumors. The MammaPrint® 70-gene expression signature has been shown to accurately predict prognosis in early breast cancer. To assess the potential predictive power of the 70-gene signature, we studied a consecutive series of 167 patients who received neoadjuvant chemotherapy for stage II or III breast cancer and whose pretreatment tumor samples contained sufficient tumor cells and had yielded RNA of adequate quality for analysis. Of these tumors, only 23 (14%) had a good prognosis signature (GPS), consistent with the fact that the group predominantly consisted of patients with locally advanced disease (stage III). Of the 144 patients in the poor prognosis signature (PPS) group, 29 (20%) achieved a pCR, whereas none of the patients with a GPS (0/23) did (P=0.015). All triple-negative (TN) tumors (ER-, PR- and HER2-) had a PPS. ER+/HER2- tumors and HER2+ tumors had a GPS in 24% (21/88) and 5% (2/41) of cases, respectively. Even when the TN-tumors were excluded from the analysis, the degree of shrinkage of the primary breast tumor continued to be associated with the outcome of the 70-gene signature (P=0.015) with less decrease in size among the GPS tumors (table). Nevertheless, after a median follow-up of 25 months, 19 relapses were seen in the poor signature and none in the good signature group. These findings indicate that a pCR is unlikely to be achieved in tumors that have a good prognosis 70-gene signature and that, at least in the neoadjuvant setting, tumors with a PPS are more sensitive to chemotherapy than those with a GPS. $$table_{595E6032-71ED-46B4-8D94-012226C7BA91}$$ Citation Information: In: Proc Am Assoc Cancer Res; 2009 Apr 18-22; Denver, CO. Philadelphia (PA): AACR; 2009. nr 1894.
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