Meme karsinomlarında neoadjuvan kemoterapi sonrası radyolojik ve histopatolojik parametrelerin analizi
The analysis of radiological and histopathological parameters after neoadjuvant chemotherapy in breast carcinoma
Yazar: ADNAN GÜNDOĞDU
Danışman: PROF. DR. ALİ GÜNER
Karadeniz Teknik Üniversitesi / Tıp Fakültesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: Genel Cerrahi = General Surgery

Özet:
Amaç: Neoadjuvan kemoterapi (NAK), hem sağkalıma hem de organ koruyucu cerrahiye olan katkılarından dolayı meme kanseri tedavisinde sıklıkla kullanılmaktadır. Çalışmanın amacı, NAK alan hastalarda patolojik tam yanıt (pCR) üzerine etki eden klinik ve patolojik faktörleri belirlemektir.
Gereç-Yöntem: Temmuz 2016- Ekim 2021 tarihleri arasında Karadeniz Teknik     Üniversitesi Tıp Fakültesi Farabi Hastanesinde, meme kanseri tanısı alarak opere edilen tüm hastalar retrospektif olarak değerlendirildi. Hastalardan 18 yaş üstü invaziv meme kanseri tanısı olan ve cerrahi öncesi NAK alan hastalar çalışma popülasyonu olarak belirlendi. Memede ve aksiller lenf nodlarında rezidü hastalık olmaması, pCR olarak tanımlandı (ypT0/is ypN0). Klinik, radyolojik, patolojik verileri ile pCR arasındaki ilişki analiz edildi.
Bulgular: Toplam 119 hasta analize dahil edilmiştir. Yaş dağılımı median 54 (IQR, 46-64) idi. Hastaların 38'inde (%31.9) meme kanseri aile öyküsü mevcuttu ve 62 hasta (%52.1) premenopozal idi. Klinik T (cT) ve N (cN) evreleri, cT1 23 (%19.3), cT2 79 (%66.4), cT3 4 (%3.4), cT4 13 (%10.9) olarak saptanırken cN0 hasta sayısı 33 (%27.7), cN1 74 (%62.2), cN2 2 (%1.7), cN3 10 (%8.4) olarak belirlendi. cT ve cN nin pCR üzerine istatistiksel anlamlı etkisi bulunmadı. Hastaların 33'ünde (%27.7) pCR izlendi. Toplam 43 (%36.1) hastada primer meme dokusunda tam yanıt izlendi. Multivariable regresyon analizinde istatistiksel anlamlı tek risk faktörü olarak moleküler alt tip saptandı. pCR oranlarının luminal-A grupta %8.7, luminal-B grupta %10.8, luminal-B HER2-pozitif grupta %42.4, HER2-pozitif grupta %54.5 ve triple negatif grupta %46.7 olduğu saptandı.
Sonuç: Bu çalışmada NAK yanıtı için en önemli belirleyicinin, tümörün moleküler alt tipi olduğu saptandı. HER2-pozitif ve triple negatif olgularda yüksek pCR gözlenirken, luminal-A ve luminal-B tümörlerde pCR oranları daha düşük saptanmıştır. 

Anahtar Kelimeler: Neoadjuvan kemoterapi, Meme kanseri, Patolojik tam yanıt

Abstract:
Objective: Neoadjuvant chemotherapy (NAC) is frequently used in the treatment of breast cancer because of its positive contributions to both survival and organ-sparing surgery. The aim of the study was to determine the clinical and pathological factors affecting the pathological complete response (pCR) of patients who received NAC.
Materials-Methods: All patients who were operated on with the diagnosis of breast cancer at Karadeniz Technical University Farabi Hospital between July 2016 and October 2021 were evaluated retrospectively. Patients over the age of 18 who were diagnosed with invasive breast cancer and received NAC before surgery were determined as the study population. The absence of residual disease in the breast and the absence of disease in the axillary lymph nodes were defined as pCR (ypT0/is ypN0). The relationship between clinical, radiological and pathological data and pCR was analyzed.
Results: A total of 119 patients were included in the analysis. The median age distribution was 54 (IQR, 46-64). There was a family history of breast cancer in 38 (31.9%) patients and 62 (52.1%) patients were premenopausal. Clinical T (cT) and N (cN) stages were determined as cT1 23 (19.3%), cT2 79 (66.4%), cT3 4 (3.4%), cT4 13 (10.9%), while the number of cN0 patients was 33 (27.7%), cN1 was determined as 74 (62.2%), cN2 2 (1.7%), cN3 10 (8.4%). There was no statistically significant effect of cT and cN on pCR. pCR was observed in 33 (27.7%) of the patients. Complete response was observed in the primary breast tissue in 43 (36.1%) patients. In the multivariable regression analysis, molecular subtype was determined as the only statistically significant risk factor. The pCR rates were 8.7% in the luminal-A group, 10.8% in the luminal-B group, 42.4% in the luminal-B HER2-positive group, 54.5% in the HER2-positive group and 46.7% in the triple negative group.
Conclusion: In the present study, it was determined that the most important determinant of NAC response was the molecular subtype of the tumor. High pCR was observed in HER2-positive and triple negative cases, while pCR rates were found to be lower in luminal-A and luminal-B tumors.
Key words: Neoadjuvant chemotheraphy, Breast cancer, Pathological complete response