P1-06-17: A New Pathological Response Index (PRI) for Neoadjuvant Chemotherapy Accurately Predicts Clinical Outcomes of Locally Advanced Breast Cancers (LAPBC).
Notice bibliographique
Résumé
Abstract Pathological complete response (pCR) after neoadjuvant chemotherapy predicts overall survival that is independent of treatment regimen. However; pCR is not a perfect surrogate for overall survival, given that a significant number of patients who did not achieve pCR also have a good prognosis and a small number of patients with pCR still develop recurrences. Furthermore, residual cancer cells after neoadjuvant therapy includes a wide range of responses from near pCR to complete resistance. In this study we performed a comprehensive pathological assessment for 245 surgical specimens of LAPBC, treated at a single institution, removed after receiving neoadjuvant anthracycline combination chemotherapy only (n=152) or with Taxane (n=93) with median follow up 42 months. Progression free survival (PFS) was used as the study endpoint. For comparison, residual cancer burden (RCB) was calculated using web calculator at www.mdanderson,org/breast_BCR. A multivariate Cox regression model revealed that size of the residual invasive carcinoma (OR; 3.2, CI 95%; 1.6−6.1, p=0.001), presence of lympho-vascular invasion (OR; 2.4, CI 95%; 1.3−4.3, p=0.004), absence of any pathological evidence of response at the site of the primary tumour or axillary lymph nodes after CT (OR; 3.2, CI 95%; 2.2−8.0, p=0.00001), and presence of at least one apical lymph node metastases (OR; 4.2, CI 95%; 1.5−6.8, p=0.003) at surgery were significantly associated with shorter PFS. These results were used to develop a pathological response index (PRI) from which 5 prognostic subgroups with distinct clinical outcomes were identified. Patients with PRI-PG1 (n=110; 49%) had a good clinical outcomes in both ER+ (3-year PFS; 91%) and ER- tumours (3-year PFS; 84%). Moreover, patients with PRI-PGI who did not show pCR (n=69) had equivalent overall and PFS as those with PRI-PG1 who achieved pCR (n=41); p=NS. Patients with PRI-PG2-5, had a 5 fold increase in the risk of progression compared to those with PRI-PG1 (HR; 5.2, CI 95%; 2.9−9.6, p≤0.0001). ER+ patients with PRI-PG3-5 (25% of ER+ cases) had shorter 3-year PFS 30%) compared to those ER+ with PRI PG1-2 (91%) despite treatment with adjuvant hormonal therapy (HR=6.5, CI 95%; 2.8−14.7, p<0.0001). Similarly, HER2 positive patients with PRI- PG3-5 (20% of HER2+ patients) showed very rapid progression within < 3 years (PFS; 10%) vs. those with PRI-PG1-2 (PFS; 82%) despite trastuzumab treatment (HR=8.4; CI 95%; 2.8−25.0, p<0.0001). In conclusion, a pathological response index including size of residual tumour, post chemotherapy lymph node pathological stage, lympho-vascular invasion and any evidence of fibrotic/response reaction following neoadjuvant chemotherapy may accurately predict the chance of disease progression, identify a greater proportion of patients (>twice as many as pCR) who could potentially benefit from the neoadjuvant chemotherapy and may be able to spared further adjuvant therapy. Furthermore this new PRI may help to improve the sensitivity of pathological response as a study end-point for predicting tumours response to a given neoadjuvant regimen and enable biological markers to be studied in a good prognostic group in additional to pCR. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-06-17.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».