Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/312846
Type: TESE
Title: Preditores de resposta à quimioterapia neoadjuvante em pacientes com carcinoma luminal de mama = Predictors of response to neoadjuvant chemotherapy in patients with luminal breast cancer
Title Alternative: Predictors of response to neoadjuvant chemotherapy in patients with luminal breast cancer
Author: Silva, Leonardo Roberto da, 1979-
Advisor: Zeferino, Luiz Carlos, 1955-
Abstract: Resumo: Introdução: Os carcinomas luminais de mama apresentam resposta variável à quimioterapia neoadjuvante. A identificação precoce das pacientes que se beneficiarão desse tratamento é importante para se evitar tratamento desnecessário e suas decorrentes toxicidades. O objetivo desse estudo é identificar preditores de resposta à quimioterapia neoadjuvante no carcinoma luminal de mama. Metodologia: Nós incluímos pacientes com carcinoma luminal de mama tratadas com quimioterapia pré-operatória em nosso serviço, no anos de 2013 e 2014. Dados demográficos, clínicos e patológicos foram coletados. Análises de imunoistoquímica para receptores de estrogênio e progesterona, HER2 e Ki67 foram realizadas em amostras obtidas antes do tratamento. A quimioterapia foi composta por esquema baseado em antraciclinas e taxanos. Resposta patológica completa (RPC) foi definida como ausência de doença invasora nas peças cirúrgicas da mama e da axila. Resultados: Foram incluídas cento e vinte pacientes, totalizando 131 tumores. As taxas de RPC foram de 6,11% na amostra geral, 5,26% para tumores luminais B-like (HER2-negativos) e 12,9% para luminais B-like (HER2-positivos). Nenhum preditor independente de RPC foi identificado. Cinquenta e dois tumores (39,7%) apresentaram resposta clínica completa, e grau histológico III (OR=9,05; IC95% 1,07-7,98; p=0,04), status pré-menopausal (OR=9,05; IC95% 2,01-40,87; p=0,004), e índice de Ki67 ? 20% (OR=2,71; IC95% 1,04-6,99; p=0,04) foram preditores independentes desse desfecho. A análise da curva ROC mostrou que o índice de Ki67 pré-tratamento tem baixo desempenho na identificação de pacientes que apresentarão resposta clínica completa (área sob a curva=0,660; IC95% 0,563-0,758). Pacientes com resposta clínica completa apresentaram maior chance de serem submetidas a cirurgia conservadora. Conclusões: A taxa de RPC é baixa entre os carcinomas luminais de mama submetidos a quimioterapia neoadjuvante. No entanto, parâmetros clinico-patológicos podem ajudar a identificar pacientes que apresentarão resposta clínica completa

Abstract: Purpose: Luminal breast cancers show a variable response to neoadjuvant chemotherapy. The early determination of those patients who will benefit from this treatment is important to avoid overtreatment and the resulting toxicity. The purpose of this study is to identify predictors of response to neoadjuvant chemotherapy in luminal breast cancer. Methods: We included patients with luminal breast cancer treated with neoadjuvant chemotherapy at the institution in 2013 and 2014. Demographic, clinical, and pathological data were collected. Immunohistochemistry analyses of estrogen and progesteron receptors, HER2 and Ki67 were conducted in samples obtained before treatment. Chemotherapy consisted in anthracycline/taxane-based scheme. Pathologic complete response was defined as the absence of invasive disease in the breast and axilla surgical specimens. Results: One hundred and twenty patients, totaling 131 tumors were included. Pathologic complete response rates were 6.11% in the overall sample, 5.26% for luminal B-like (HER2-negative) tumors and 12.9% for luminal B-like (HER2-positive) tumors. None independent predictor of pathologic complete response was identified. Fifty-two tumors (39,7%) showed complete clinical response, and histologic grade III (OR=2.92; 95% CI 1.07-7.98; p = 0.04), premenopausal status (OR=9.05, 95% CI 2.01-40.87; p = 0.004), Ki67 index ? 20% (OR=2.71, 95% CI 1.04 to 6,99; p = 0.04) were independent predictors for this outcome. ROC curve analysis showed that Ki67 index has a poor performance in identifying patients who will present complete clinical response (area under the curve=0.660, 95% CI 0.563-0.758). Patients with complete clinical response were more likely to be submitted to conservative surgery. Conclusions: Pathologic complete response rate is low among luminal tumors undergoing neoadjuvant chemotherapy. However, clinicopathological parameters can help identify patients who will present complete clinical response
Subject: Terapia neoadjuvante
Neoplasias da mama
Antígeno Ki-67
Critérios de avaliação de resposta em tumores sólidos
Editor: [s.n.]
Date Issue: 2015
Appears in Collections:FCM - Dissertação e Tese

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