br Corresponding author Department of Surgery School of Medi
* Corresponding author. Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hos-
1015-9584/ª 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article as: Park YR et al., Absence of L-Glutamine receptor is associated with worse oncologic outcome in patients who were received neoadjuvant chemotherapy for breast cancer, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.05.010
Conclusion: The absence of ER in breast cancer before and after NAC would be a significant prognostic factor for local recurrence and distant metastasis. Therefore, the absence of ER should be considered as important factor in determining the treatment strategy.
ª 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Breast cancer is a very heterogeneous disease, showing various molecular subtypes and different prognoses. Based on molecular subtypes, hormone receptor (þ) breast can-cer shows better prognosis, HER2 (þ) or triple negative breast cancer (TNBC) show worse prognosis.1e3 Therefore, neoadjuvant chemotherapy (NAC) is considered when the clinical stage is high or when low clinical stage HER2 (þ) breast cancer or TNBC is detected.4e6
NAC can be a therapeutic option for locally advanced breast cancers that allows breast and axillary lymph node preservation. Approximately 50e60% of the patients un-dergoing NAC are eligible for breast-conserving surgery, and 40e60% of the patients experience conversion of pathologic node-negative from clinical node-positive.7e10 Therefore, in recent years, sentinel lymph node biopsy is recom-mended in patients with node-negative conversion after
NAC rather than immediate axillary lymph node dissec-tion.11,12 This protects patients from the many complica-
tions that could arise after axillary lymph node dissection. However, the results of immunohistochemical (IHC) staining are occasionally different before and after NAC. Approximately 20e30% of estrogen receptor (ER) and pro-
gesterone receptor (PR) and less than 10% HER2 gene show alteration after NAC.13,14
We compared the results of IHC staining before and after NAC, and evaluated the association with disease prognosis and oncologic results in breast cancer.
Between 2011 and 2013, fifty-seven patients with breast cancer, who underwent NAC in Kyungpook National Uni-versity Hospital, were enrolled in this study. Most of the patients were diagnosed with invasive ductal carcinoma, and only one patient was diagnosed with metaplastic car-cinoma, via needle biopsy.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of the Kyungpook National University Chilgok Hospital (KNUCH 2015-05-205).
Molecular subtyping was based on the immunohisto-chemical assessment of the ER, PR, and HER2/neu gene amplification by silver in situ hybridization (SISH). The Ki67 proliferation index was considered to be high when >15% tumor cells showed nuclear immunoreactivity. The criteria
in the ASCO/CAP 2016 guidelines were followed for the histopathological examination of four biomarkers.
The treatment strategy was decided on the basis of T, N stage and the histological subtype of the breast cancer, which were determined through discussions by a multidis-ciplinary team comprising breast surgeons, oncologists, radiologists, pathologists, radiation oncologists, and plastic surgeons. When NAC was chosen as the treatment regimen, four cycles of Adriamycin and cyclophosphamide followed by four cycles of docetaxel were administered, and the therapeutic response was assessed every three months via mammography, breast ultrasonography, breast MR, positron emission tomography/computed tomography (PET/CT), and bone scans.