Hubungan Konversi Reseptor Kanker Payudara Paska Kemoterapi Neoadjuvan dengan Disease Free Survival
Terry Soebhi, dr. Suwardjo Sp.B.Subsp. Onk(K); Prof. Dr. dr. Teguh Aryandono Sp.B.Subsp. Onk(K); dr. Paranita Ferronika, Phd., Sp.PA(K)
2024 | Tesis-Subspesialis | SUBSPESIALIS ILMU BEDAH
Background
Molecular subtyping of breast cancer based on the status of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 is important as prognostic and therapeutic information. Previous studies show that this prognostic factor has been confirmed as conversion/differences in the appearance of ER, PR, and HER2 receptors between primary tumors of pre- and post-neoadjuvant chemotherapy. Further investigation into this difference can affect patients’ prognosis. The specific mechanism of change in these receptors is still not revealed. However, we can reassess the correlation of this conversion with biological characteristics and epidemiological factors such as race that may influence patients’ prognosis.
Research Methods
This research was conducted in a retrospective observational analytic cohort, involving 165 patients who were diagnosed with operable and locally advanced breast cancer at RSUP Dr. Sardjito in 2015-2022. The status of ER, PR, HER2, and Ki67 was examined using the immunohistochemistry (IHC) method using tumor tissue from paraffin blocks of pre- and post-neoadjuvant chemotherapy (NAC). Survival analysis was conducted using the Kaplan-Meier method, univariate test of prognostic factors was done using the log-rank test, and Cox regression analysis conducted to calculate the hazard ratio as a response variable to the independent variable with confidence intervals and significant values with a P-value <0>
Research Result
Out of the 165 cases in this study, 35 cases (21%) experienced conversion and 130 cases did not experience conversion after NAC. Conversion of hormone receptors to positive showed a longer disease-free survival (DFS) compared to persistent negative hormone receptors, and hormone receptors that converted to negative have faster DFS than persistent positive hormone receptors. This was the opposite of the HER2 receptor. With the log-rank test p<0>0.1. However, the Hazard Ratio showed that each of these receptor changes had a different risk of relapse and metastasis from cases where the receptor persisted.
Conclusion
Immunohistochemistry conversion after neoadjuvant chemotherapy can be associated with DFS. This conversion has a good effect on DFS if there is conversion to hormone-positive. However, if there is a conversion to HER2 positive, it can worsen the DFS in cases that do not receive targeted therapy.
Kata Kunci : molecular subtyping, NAC, IHC conversion, DFS