Her-2 pozitif meme kanserli hastalarda neoadjuvan kemoterapi sonrası her-2 diskordansı ve prognoz üzerine etkisi
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Tarih
2024
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kadınlarda en sık görülen kanser türü meme kanserd4r. Kansere bağlı ölümler arasında
4k4nc4 en sık görülen kanser türüdür. Meme kanser4 de d4ğer kanser türler4 g4b4 erken tanı
aldığında ve tedav4ye erken başlanıldığında tam yanıt alınab4len, ölüm oranlarında azalma
sağlanılan, kür sağlanılab4len ve tedav4s4 olan b4r kanser türüdür. Son yıllarda yapılan
çalışmalarda yen4 tedav4 modal4teler4 gel4şt4r4lm4şt4r. Lokal 4ler4 meme kanser4nde Neoadjuvan
kemoterap4 (NAKT) standart tedav4d4r. NAKT' ye patoloj4k tam yanıt (pCR) sağlamak
hastalıksız sağ kalım oranlarının ve hastaların morb4d4te, mortal4te oranlarının azalması
açısından onkoloj4k ve kl4n4k olarak öneml4 b4r hal almaktadır. Hastaların tedav4 yanıtını ve
prognozlarını bel4rlemek 4ç4n çeş4tl4 b4yobel4rteçler tesp4t ed4lm4şt4r. HER2 bu bel4rteçlerden
b4r4d4r. Ant4-HER2 tedav4ler4n HER2 poz4t4f hastalarda kemoterap4ye eklenmes4yle onkoloj4k
açıdan anlamlı 4y4leşmeler yapılan çalışmalarda tesp4t ed4lm4şt4r. Son zamanlarda yapılan
çalışmalarda Neoadjuvan tedav4 sonrası HER2 değer4nde değ4şmeler4n olduğu tesp4t ed4lm4ş ve
bu değ4ş4m4n prognoz üzer4nde etk4s4 çalışmalara konu olmuştur. Bu çalışmada kl4n4ğ4m4zde
HER2 poz4t4f meme kanserl4 hastalarda neoadjuvan tedav4 sonrası HER2’dek4 değ4ş4m4 ve bu
değ4ş4m4n prognoz üzer4ndek4 etk4s4n4 araştırmayı amaçladık.
Yöntem: Çalışmaya Meram Tıp Fakültes4 Hastanes4 Tıbb4 Onkoloj4 Kl4n4ğ4ne 2010-2023
yılları arasında başvuran, HER2 poz4t4f meme kanser4 tanısı konulan ve neoadjuvan tedav4 alan,
tedav4 sonrası cerrah4 yapılan 105 hasta dah4l ed4ld4. Hastaların tıbb4 arş4v dosyalarından elde
ed4len demograf4k, kl4n4k, patoloj4k, radyoloj4k, laboratuvar tahl4l sonuçlarının özell4kler4
retrospekt4f olarak 4ncelend4. Çalışmada HER2 poz4t4f meme kanser4 tanısı alan hastaların
neoadjuvan tedav4 sonrası HER2 değ4ş4m4 ve bu değ4ş4m4n prognoz üzer4ndek4 etk4s4
4stat4st4ksel anal4zler yapılarak değerlend4r4ld4.
Bulgular: HER2 + olan ve NAKT alan hastalarda HER2 d4skordansının ve bu d4skordansın
prognoz üzer4ne etk4s4n4n araştırıldığı çalışmamızda 105 hasta mevcuttu. Bu hastaların %80’
4ne neoadjuvan tedav4 olarak trastuzumab ver4ld4ğ4, %81,9’ unda adjuvan HER2 tedav4s4n4
tamamladığı tesp4t ed4ld4. Hastaların %41’ 4nde patoloj4k tam yanıt vardı. Hastaların %14,3’
ünde HER-2 2+, %78,6’ sında HER-2 3+’ t4. Patoloj4k tam yanıt görülmeyen 62 hastanın tanı
yaşı ortalaması 52,79 4d4. Patoloj4k tam yanıt görülenler4n k4loları, vücut yüzey alanı ve VKİ’ 4
tam yanıt görülmeyenlerden daha düşük saptandı (p<0,05). Patoloj4k tam yanıt görülmeyenler4n
VKİ gruplamasında obez olma oranı anlamlı daha yüksekt4 (p=0,007). Patoloj4k tam yanıt
görülmeyenlerde patoloj4k tümör çapı, poz4t4f lenf nodu sayısı daha yüksek saptandı(p<0,001).
Hastaların patoloj4k tam yanıt varlığı 4le genel ve progresyonsuz sağkalım süres4 arasında
4stat4st4ksel olarak anlamlı fark saptanmadı (sırasıyla p=0,513; p=0,941). Patoloj4k tam yanıt
görülmeyen 62 hastadak4 HER2 değ4ş4m4 4ncelend4ğ4nde hastaların %56,5’ 4nde(n=35) HER2
değ4ş4m4 olmadığı (poz4t4f-poz4t4f), %43,5’ 4nde (n=27) HER2 değ4ş4m4 olduğu (poz4t4f-negat4f)
saptandı. HER2 değ4ş4m4 olan ve olmayan hastaların tanı yaşı, k4lo, vücut yüzey alanı, VKİ
benzerd4 (p>0,05). HER2 değ4ş4m4 olan ve olmayan hastalarda tanı yaş grubu, VKİ grubu
açısından anlamlı farklılık saptanmadı (p>0,05). HER-2 değ4ş4m4 olan ve olmayan hastaların
b4yops4de östrojen ve progesteron poz4t4fl4ğ4 görülme oranı, cerrah4 DCIS, LVİ, PNİ varlığı,
patoloj4k tümör çapı, poz4t4f lenf nodu sayısı ve cerrah4 k4-67 oranları benzerd4. HER-2
değ4ş4m4n4n hastaların genel sağkalım süres4 üzer4nde anlamlı etk4s4 olmadığı saptandı
(p=0,273). HER-2 cevabının progresyonsuz sağkalım süres4 üzer4nde anlamlı etk4s4 olmadığı
bel4rlend4 (p=0,491).
Sonuç: Neoadjuvan kemoterap4 sonrası hastaların %43' ünde HER2 d4skordansı saptanmıştır.
HER2 d4skordansı olanlar ve olmayanlar arasında hastalıksız ve genel sağkalım açısından
anlamlı farklılık saptanmamıştır.
ObjectHve: Breast cancer 4s the most common type of cancer 4n women. It 4s the second most common type of cancer among cancer-related deaths. Breast cancer, l4ke other types of cancer, 4s a type of cancer that can be fully responded to, mortal4ty rates can be reduced, cure can be ach4eved and treatment 4s ava4lable when d4agnosed early and treatment 4s started early. New treatment modal4t4es have been developed 4n recent years. Neoadjuvant chemotherapy (NACT) 4s the standard treatment for locally advanced breast cancer. Ach4ev4ng a patholog4c complete response (pCR) to NACT 4s becom4ng oncolog4cally and cl4n4cally 4mportant 4n terms of decreas4ng d4sease-free surv4val rates and morb4d4ty and mortal4ty rates of pat4ents. Var4ous b4omarkers have been 4dent4f4ed to determ4ne the treatment response and prognos4s of pat4ents. HER2 4s one of these markers. Oncolog4cally s4gn4f4cant 4mprovements have been detected 4n stud4es w4th the add4t4on of ant4-HER2 therap4es to chemotherapy 4n HER2 pos4t4ve pat4ents. In recent stud4es, changes 4n HER2 values after neoadjuvant treatment have been detected and the effect of th4s change on prognos4s has been the subject of stud4es. In th4s study, we a4med to 4nvest4gate the change 4n HER2 after neoadjuvant treatment and the effect of th4s change on prognos4s 4n HER2 pos4t4ve breast cancer pat4ents 4n our cl4n4c. Method: The study 4ncluded 104 pat4ents who were adm4tted to the Med4cal Oncology Cl4n4c of Meram Med4cal Faculty Hosp4tal between 2010 and 2023, d4agnosed w4th HER2 pos4t4ve breast cancer, rece4ved neoadjuvant treatment and underwent surgery after treatment. Demograph4c, cl4n4cal, patholog4c, patholog4c, rad4olog4c and laboratory test results obta4ned from the med4cal arch4ve f4les of the pat4ents were retrospect4vely analyzed. HER2 change after neoadjuvant treatment 4n HER2 pos4t4ve breast cancer pat4ents and the effect of th4s change on prognos4s were evaluated by stat4st4cal analys4s. Results: In our study 4nvest4gat4ng HER2 d4scordance and 4ts effect on prognos4s 4n HER2+ pat4ents rece4v4ng NACT, 105 pat4ents were 4ncluded. It was determ4ned that 80% of these pat4ents rece4ved transtuzumab as neoadjuvant treatment and 81.9% completed adjuvant HER2 treatment. 41% of the pat4ents had patholog4cal complete response. HER-2 was 2+ 4n 14.3% and HER-2 was 3+ 4n 78.6% of the pat4ents. The mean age at d4agnos4s of 62 pat4ents w4thout patholog4cal complete response was 52.79 years. The we4ght, body surface area and BMI of pat4ents w4th patholog4cal complete response were lower than those w4thout patholog4cal complete response (p<0.05). The rate of obes4ty was s4gn4f4cantly h4gher 4n the BMI group4ng of those w4thout patholog4cal complete response (p=0.007). The presence of surg4cal DCIS 4n pat4ents w4thout patholog4cal complete response was s4gn4f4cantly h4gher than 4n pat4ents w4th patholog4cal complete response (p<0.001). Patholog4cal tumour d4ameter and number of pos4t4ve lymph nodes were s4gn4f4cantly h4gher 4n pat4ents w4thout patholog4cal complete response (p<0.001). There was no stat4st4cally s4gn4f4cant d4fference between the presence of patholog4cal complete response and overall and progress4on-free surv4val (p=0.513; p=0.941, respect4vely). When HER2 change 4n 62 pat4ents who d4d not have patholog4cal complete response was analysed, 4t was found that 56.5% (n=35) had no HER2 change (pos4t4ve-pos4t4ve) and 43.5% (n=27) had HER2 change (pos4t4ve-negat4ve). Age at d4agnos4s, we4ght, body surface area and BMI were s4m4lar 4n pat4ents w4th and w4thout HER2 change (p>0.05). There was no s4gn4f4cant d4fference between pat4ents w4th and w4thout HER2 alterat4on 4n terms of age at d4agnos4s and BMI group (p>0.05). The rate of estrogen and progesterone pos4t4v4ty 4n b4opsy, presence of surg4cal DCIS, LVI, PNI, patholog4cal tumour d4ameter, number of pos4t4ve lymph nodes, and surg4cal k4-67 rates were s4m4lar 4n pat4ents w4th and w4thout HER-2 exchange. HER-2 change was found to have no s4gn4f4cant effect on overall surv4val (p=0,273). HER-2 response had no s4gn4f4cant effect on progress4on-free surv4val (p=0,491). ConclusHon: HER2 d4scordance was detected 4n 43% of pat4ents after neoadjuvant chemotherapy. There was no s4gn4f4cant d4fference 4n d4sease-free and overall surv4val between pat4ents w4th and w4thout HER2 d4scordance.
ObjectHve: Breast cancer 4s the most common type of cancer 4n women. It 4s the second most common type of cancer among cancer-related deaths. Breast cancer, l4ke other types of cancer, 4s a type of cancer that can be fully responded to, mortal4ty rates can be reduced, cure can be ach4eved and treatment 4s ava4lable when d4agnosed early and treatment 4s started early. New treatment modal4t4es have been developed 4n recent years. Neoadjuvant chemotherapy (NACT) 4s the standard treatment for locally advanced breast cancer. Ach4ev4ng a patholog4c complete response (pCR) to NACT 4s becom4ng oncolog4cally and cl4n4cally 4mportant 4n terms of decreas4ng d4sease-free surv4val rates and morb4d4ty and mortal4ty rates of pat4ents. Var4ous b4omarkers have been 4dent4f4ed to determ4ne the treatment response and prognos4s of pat4ents. HER2 4s one of these markers. Oncolog4cally s4gn4f4cant 4mprovements have been detected 4n stud4es w4th the add4t4on of ant4-HER2 therap4es to chemotherapy 4n HER2 pos4t4ve pat4ents. In recent stud4es, changes 4n HER2 values after neoadjuvant treatment have been detected and the effect of th4s change on prognos4s has been the subject of stud4es. In th4s study, we a4med to 4nvest4gate the change 4n HER2 after neoadjuvant treatment and the effect of th4s change on prognos4s 4n HER2 pos4t4ve breast cancer pat4ents 4n our cl4n4c. Method: The study 4ncluded 104 pat4ents who were adm4tted to the Med4cal Oncology Cl4n4c of Meram Med4cal Faculty Hosp4tal between 2010 and 2023, d4agnosed w4th HER2 pos4t4ve breast cancer, rece4ved neoadjuvant treatment and underwent surgery after treatment. Demograph4c, cl4n4cal, patholog4c, patholog4c, rad4olog4c and laboratory test results obta4ned from the med4cal arch4ve f4les of the pat4ents were retrospect4vely analyzed. HER2 change after neoadjuvant treatment 4n HER2 pos4t4ve breast cancer pat4ents and the effect of th4s change on prognos4s were evaluated by stat4st4cal analys4s. Results: In our study 4nvest4gat4ng HER2 d4scordance and 4ts effect on prognos4s 4n HER2+ pat4ents rece4v4ng NACT, 105 pat4ents were 4ncluded. It was determ4ned that 80% of these pat4ents rece4ved transtuzumab as neoadjuvant treatment and 81.9% completed adjuvant HER2 treatment. 41% of the pat4ents had patholog4cal complete response. HER-2 was 2+ 4n 14.3% and HER-2 was 3+ 4n 78.6% of the pat4ents. The mean age at d4agnos4s of 62 pat4ents w4thout patholog4cal complete response was 52.79 years. The we4ght, body surface area and BMI of pat4ents w4th patholog4cal complete response were lower than those w4thout patholog4cal complete response (p<0.05). The rate of obes4ty was s4gn4f4cantly h4gher 4n the BMI group4ng of those w4thout patholog4cal complete response (p=0.007). The presence of surg4cal DCIS 4n pat4ents w4thout patholog4cal complete response was s4gn4f4cantly h4gher than 4n pat4ents w4th patholog4cal complete response (p<0.001). Patholog4cal tumour d4ameter and number of pos4t4ve lymph nodes were s4gn4f4cantly h4gher 4n pat4ents w4thout patholog4cal complete response (p<0.001). There was no stat4st4cally s4gn4f4cant d4fference between the presence of patholog4cal complete response and overall and progress4on-free surv4val (p=0.513; p=0.941, respect4vely). When HER2 change 4n 62 pat4ents who d4d not have patholog4cal complete response was analysed, 4t was found that 56.5% (n=35) had no HER2 change (pos4t4ve-pos4t4ve) and 43.5% (n=27) had HER2 change (pos4t4ve-negat4ve). Age at d4agnos4s, we4ght, body surface area and BMI were s4m4lar 4n pat4ents w4th and w4thout HER2 change (p>0.05). There was no s4gn4f4cant d4fference between pat4ents w4th and w4thout HER2 alterat4on 4n terms of age at d4agnos4s and BMI group (p>0.05). The rate of estrogen and progesterone pos4t4v4ty 4n b4opsy, presence of surg4cal DCIS, LVI, PNI, patholog4cal tumour d4ameter, number of pos4t4ve lymph nodes, and surg4cal k4-67 rates were s4m4lar 4n pat4ents w4th and w4thout HER-2 exchange. HER-2 change was found to have no s4gn4f4cant effect on overall surv4val (p=0,273). HER-2 response had no s4gn4f4cant effect on progress4on-free surv4val (p=0,491). ConclusHon: HER2 d4scordance was detected 4n 43% of pat4ents after neoadjuvant chemotherapy. There was no s4gn4f4cant d4fference 4n d4sease-free and overall surv4val between pat4ents w4th and w4thout HER2 d4scordance.
Açıklama
Anahtar Kelimeler
HER2 Poz4t4fl4ğ4, HER2 Pos4t4v4ty, Neoadjuvan Tedav4, Neoadjuvant Therapy, Immunh4stok4mya, Immunoh4stochem4stry, HER2 Değ4ş4m4, HER2 Change, Prognoz, Prognos4s
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kul, A. (2024). Her-2 pozitif meme kanserli hastalarda neoadjuvan kemoterapi sonrası her-2 diskordansı ve prognoz üzerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
