Response and Long-Term Effect of Patients with Triple-Negative Breast Cancer Receiving Neo-Adjuvant Anthracycline-Based

摘要

OBJECTIVE The breast cancer lack of expression of estrogenreceptor (ER), progesterone receptor (PR), and human epidermalgrowth factor receptor 2 (HER-2) is defined as the Triple-negativebreast cancer (TNBC). Our purpose is to compare the responseand long-term effect of the TNBC and non-TNBC patientsreceiving neo-adjuvant anthracycline-based chemotherapy, and toinvestigate the mechanisms of TNBC affecting the survivals.METHODS Data of long-term follow-up (median, 5.4 years)of 326 patients who received neo-adjuvant chemotherapy withanthracycline-based regimen, during a period from 2000 to 2003,were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 andE-cadherin were determined using immunohistochemical stainingmethod. A multivariate Cox regression analysis was used toanalyze independent prognostic factors affecting the relapse-freesurvival (RFS) and overall survival (OS) rates. Clinical effects ofthe neo-adjuvant anthracycline-based chemotherapeutic regimenand the RFS and OS rates were compared between the patientswith TNBC and non-TNBC, and the correlations among the triple-negative phenotype (TNP), tumor grading and the expressions ofP53, Ki-67 and E-cadherins were analyzed.RESULTS TNP, TNM staging, histological grades, clinicalresponse of the neo-adjuvant chemotherapy and pathologicalcomplete remission (pCR) rate were the independent prognosticfactors affecting the survival rates. Furthermore, 70 (21.5%) of the326 patients suffered TNBC. Compared with the subjects in non-TNBC group, the patients with TNBC had a significantly higherpCR rate (P = 0.046) and clinical response rate (P = 0.037), but alsodecreased 5-year RFS (P = 0.001) and OS (P = 0.004) rates. TheRFS and OS rates were not improved in the TNBC patients whoachieved a clinical remission after the neo-adjuvant chemotherapy.The triple-negative phenotype was positively correlated with thelevel of P53, Ki-67 expression (P = 0.007, P = 0.028), but negativelycorrelated with level of E-cadherin (P = 0.034).CONCLUSION Both clinical remission rate and pCR rate ofthe TNBC patients receiving neo-adjuvant anthracycline-basedchemotherapy are high, however, the long-term effect is poor.The mechanism may relate to a strong potential of proliferationand invasive metastasis, as well as lack of an effective therapeutictarget in the TNBC patients.