热烈祝贺www.911sss.com服务器升级完毕,全固态硬盘,50G超大带宽,满足你的 一切数据查看需求!

公告:郑重承诺:资源永久免费,资源不含任何联盟富媒体弹窗广告,只有三次走马灯水印广告(承诺绝不影响用户体验)


当前位置
首页  »  SIBCS  »  整合治疗反应+肿瘤分级+受体状态提高新辅助化疗分期质量


  新辅助化疗生物学评分(Neo-Bioscore)是德克萨斯大学MD安德森癌症中心提出的改良分期系统,整合了临床病理学分期+雌激素受体和分级(CPS+EG)以及HER2状态,可以较好预测乳腺癌患者接受新辅助化疗后的生存情况。


  2017年8月21日,美国乳腺外科医师学会、外科肿瘤学会《外科肿瘤学年鉴》在线发表梅奥医院的全国队列研究报告,评估了上述分期系统的可推广性和表现。


  该研究通过回顾分析2006~2012年全国癌症数据库,筛选出接受新辅助化疗且术后生存≥90天的乳腺癌患者共43420例,对四个分期系统进行评估:美国癌症联合委员会(AJCC)第7版临床和病理学分期、CPS+EG、新辅助化疗生物学评分。使用校正前生存曲线分析、校正后比例风险模型对总生存进行量化,使用曲线下面积和整合判别力改善指数,对四个分期系统进行比较。


  结果发现,43420例患者的5年总生存率为76.0%(95%置信区间:75.4~76.5%),其中12002例可以进行新辅助化疗生物学评分。


  CPS+EG、新辅助化疗生物学评分与 AJCC 临床、病理学分期相比,5年生存曲线下面积较大:0.720、0.729、0.650、0.683(95%置信区间:0.714~0.726、0.716~0.742、0.643~0.656、0.676~0.689)。


  CPS+EG、新辅助化疗生物学评分与 AJCC 病理学分期相比,5年整合判别力改善指数较高:7.2%、9.8%、3.0%(95%置信区间:6.6~7.7%、8.0~11.6%、2.4~3.6%)。


  CPS+EG与新辅助化疗生物学评分相比,5年整合判别力改善指数相差2.6%(95%置信区间:0.9~4.5%),表明新辅助化疗生物学评分为最佳分期系统。


  因此,在接受新辅助化疗+手术治疗的乳腺癌患者大样本全国队列中,整合化疗反应+肿瘤分级+雌激素受体状态+HER2状态的分期系统与AJCC的TNM分期系统相比,大大提高了对总生存的判别力,新辅助化疗生物学评分(Neo-Bioscore)提供了最佳的分期判别力,可以较好预测乳腺癌患者接受新辅助化疗后的生存情况。


相关阅读


Ann Surg Oncol. 2017 Aug 21. [Epub ahead of print]


Incorporation of Treatment Response, Tumor Grade and Receptor Status Improves Staging Quality in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy.


Muhsen S, Barrio AV, Miller M, Olcese C, Patil S, Morrow M, Van Zee KJ.


Mayo Clinic Rochester, Rochester, MN, USA.


BACKGROUND: Improved staging systems that better predict survival for breast cancer patients who receive neoadjuvant chemotherapy (NAC) by accounting for clinical pathological stage plus estrogen receptor (ER) and grade (CPS+EG) and ERBB2 status (Neo-Bioscore) have been proposed. We sought to evaluate the generalizability and performance of these staging systems in a national cohort.


METHODS: The National Cancer Database (2006-2012) was reviewed for patients with breast cancer who received NAC and survived ≥90 days after surgery. Four systems were evaluated: clinical/pathologic American Joint Committee on Cancer (AJCC) 7th edition, CPS+EG, and Neo-Bioscore. Unadjusted Kaplan-Meier analysis and adjusted Cox proportional hazards models quantified overall survival (OS). Systems were compared using area under the curve (AUC) and integrated discrimination improvement (IDI).


RESULTS: Overall, 43,320 patients (5-year OS 76.0, 95% confidence interval [CI] 75.4-76.5%) were included, 12,002 of whom had evaluable Neo-Bioscore. AUC at 5 years for CPS+EG (0.720, 95% CI 0.714-0.726) and Neo-Bioscore (0.729, 95% CI 0.716-0.742) were improved relative to AJCC clinical (0.650, 95% CI 0.643-0.656) and pathologic (0.683, 95% CI 0.676-0.689) staging. Both CPS+EG (IDI 7.2, 95% CI 6.6-7.7%) and Neo-Bioscore (IDI 9.8, 95% CI 8.0-11.6%) demonstrated superior discrimination when compared with AJCC clinical staging at 5 years. Comparison of CPS+EG with Neo-Bioscore yielded an IDI of 2.6% (95% CI 0.9-4.5%), indicating that Neo-Bioscore is the best staging system.


CONCLUSIONS: In a heterogenous national cohort of breast cancer patients treated with NAC and surgery, the incorporation of chemotherapy response, tumor grade, ER status, and ERBB2 status into the staging system substantially improved on the AJCC TNM staging system in discrimination of OS. Neo-Bioscore provided the best staging discrimination.


PMID: 28828583


DOI: 10.1245/s10434-017-6010-4










复制下列地址至浏览器地址栏即可观看,本站不提供在线正版。备注:如有地址错误,请点击→ 我要报错 向我们报错!我们将在第一时间处理!谢谢!
  • 本网站所有内容均收集于互联网主流视频网站,不提供在线正版播放。
  • Copyright ©2017 All Rights Reserved www.911sss.com