Evaluación de la respuesta patológica postquimioterapia neoadyuvante en carcinoma de mama invasor, mediante la escala "Residual Cáncer Burden", ION-SOLCA, 2015-2017
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2017
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Introducción: La escala “Residual Cancer Burden” (RCB), evalúa la respuesta patológica
del cáncer de mama al tratamiento oncoespecífico (TO), mediante estudio histológico de la
respectiva biopsia post-terapéutica. Además de valorar la respuesta patológica al TO,
permite predecir la expectativa de vida en pacientes con cáncer de mama receptores
hormonales o Her2Neu positivo. Desde el 2015 se utiliza el RCB en el ION-SOLCA. En
nuestro conocimiento, se desconoce la utilidad de este instrumento en una población
ecuatoriana con cáncer de mama invasor. Objetivo: Evaluar la respuesta patológica
postquimioterapia neoadyuvante en carcinoma de mama invasor, en pacientes del ION
SOLCA durante el periodo 2015 – 2017, a fin de establecer la utilidad de la escala
“Residual Cancer Burden” en el pronóstico de sobrevida global. Metodología: Estudio no
experimental de corte transversal, realizado entre enero-2015 a junio-2017. Se consideró
variables como: diagnóstico histopatológico inicial, TO, diagnóstico histopatológico post-
TO (RCB) y situación actual. La relación entre la inmunohistoquímica, el TO, RCB y el
desenlace negativo (progresión y/o fallecimiento) fue estimada mediante medidas de
asociación. Resultados: Se recuperó un total de 146 pacientes: RCB ausente, mínima,
moderada y severa presente en 9/146, 5/146, 55/146 y 77/146 pacientes, respectivamente.
Existió una relación estadísticamente significativa entre la indicación de Trastuzumab en
pacientes HER2/neu positivos, y la respuesta patológica calificada por RCB (OR 3,5;
p<0,05). No obstante, su relación para con la supervivencia fue poco significativa (HR 1,3:
p = 0,727). La relación de la expresión de RE + hormonoterapia, para con RCB fue
estadísticamente poco significativa (OR 1,7; p =0,131), a pesar de presentar una asociación
muy significativa para con la supervivencia (HR 0,100; p<0,05). Finalmente, existe una
fuerte asociación entre RCB y la sobrevida global (HR 8,483; p<0,05). Conclusión: La
escala “Residual Cancer Burden” constituye un instrumento útil en la predicción de
sobrevida global en carcinoma de mama invasor postquimioterapia neoadyuvante.
Palabras claves: Neoplasias de la Mama. Neoplasia Residual. Quimioterapia. (fuente:
Introduction: The “Residual Cancer Burden” (RCB) scale evaluates the pathological response of breast cancer to oncospecific treatment (OT), by histological study of the respective post-therapeutic biopsy. In addition to assessing the pathological response to OT, it allows the prediction of life expectancy in patients with breast cancer hormone receptors or Her2Neu positive. Since 2015, the RCB has been used in the ION-SOLCA. In our knowledge, the profitability of this instrument in an Ecuadorian population with invasive breast cancer is unknown. Aim: To evaluate the neoadjuvant post-chemotherapy pathological response in invasive breast carcinoma in ION SOLCA patients during the period 2015 - 2017, in order to establish the utility of the "Residual Cancer Burden" scale in the global survival forecast. Methods: Non-experimental cross-sectional study, conducted between January-2015 to June-2017. Variables were considered as: initial histopathological diagnosis, TO, histopathological diagnosis post-OT (RCB) and current situation. The evaluation of the relationship between immunohistochemistry, OT, RCB and the negative outcome (progression and/or death) was estimated by means of association measures. Results: A total of 146 patients were recovered: absent, minimal, moderate and severe RCB present in 9/146, 5/146, 55/146 and 77/146 patients, respectively. There was a statistically significant relationship between the indication of Trastuzumab in HER2/neu positive patients, and the pathological response rated by RCB (OR 3.5, p <0.05). However, its relation to survival was not significant (HR 1.3: p = 0.727). The relationship between the expression of ER + hormonotherapy for BCR was statistically insignificant (OR 1.7, p = 0.131), despite having a very significant association with survival (HR 0.100, p <0.05). Finally, there is a strong association between RCB and overall survival (HR 8.483, p <0.05). Conclusion: The "Residual Cancer Burden" scale is a useful tool in the prediction of global survival in neoadjuvant post-chemotherapy invasive breast carcinoma.
Introduction: The “Residual Cancer Burden” (RCB) scale evaluates the pathological response of breast cancer to oncospecific treatment (OT), by histological study of the respective post-therapeutic biopsy. In addition to assessing the pathological response to OT, it allows the prediction of life expectancy in patients with breast cancer hormone receptors or Her2Neu positive. Since 2015, the RCB has been used in the ION-SOLCA. In our knowledge, the profitability of this instrument in an Ecuadorian population with invasive breast cancer is unknown. Aim: To evaluate the neoadjuvant post-chemotherapy pathological response in invasive breast carcinoma in ION SOLCA patients during the period 2015 - 2017, in order to establish the utility of the "Residual Cancer Burden" scale in the global survival forecast. Methods: Non-experimental cross-sectional study, conducted between January-2015 to June-2017. Variables were considered as: initial histopathological diagnosis, TO, histopathological diagnosis post-OT (RCB) and current situation. The evaluation of the relationship between immunohistochemistry, OT, RCB and the negative outcome (progression and/or death) was estimated by means of association measures. Results: A total of 146 patients were recovered: absent, minimal, moderate and severe RCB present in 9/146, 5/146, 55/146 and 77/146 patients, respectively. There was a statistically significant relationship between the indication of Trastuzumab in HER2/neu positive patients, and the pathological response rated by RCB (OR 3.5, p <0.05). However, its relation to survival was not significant (HR 1.3: p = 0.727). The relationship between the expression of ER + hormonotherapy for BCR was statistically insignificant (OR 1.7, p = 0.131), despite having a very significant association with survival (HR 0.100, p <0.05). Finally, there is a strong association between RCB and overall survival (HR 8.483, p <0.05). Conclusion: The "Residual Cancer Burden" scale is a useful tool in the prediction of global survival in neoadjuvant post-chemotherapy invasive breast carcinoma.
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Neoplasias de la mama, Neoplasia residual, Quimioterapia, Estudios retrospectivos, Epidemiología analítica, Cantón Guayaquil, Ecuador, Escala Residual Cáncer Burden, Hospital SOLCA de Guayaquil