新辅助化疗（NCT）通过降低大型原发性乳腺肿瘤和淋巴结受累的分期，增加手术切除的可行性，可能导致手术减弱和改善预后。本文来自多机构新辅助治疗MammaPrint项目I（MINT）试验的亚分析评估了MammaPrint和BluePrint与淋巴结分期的关联。前瞻性MINT试验（NCT01501487）招募了387名于2011年至2016年之间年龄≥18岁的有浸润性乳腺癌（T2-T4）的患者。这次亚分析包括146名接受NCT的II-III期淋巴结阳性患者。MammaPrint将肿瘤分层为低危和高危远处转移风险。与MammaPrint一起，BluePrint基因分类（g）将肿瘤分为gLuminal A、gLuminal B、gHER2或gBasal。总体上，45.2%（n = 66/146）的患者有完全淋巴结分期下降，其中60.6%（n = 40/66）实现了病理学完全缓解。MammaPrint和联合MammaPrint和BluePrint与淋巴结分期下降显著相关（p = 0.007和p < 0.001）。与低危相比，MammaPrint高危肿瘤的患者中有更高比例的患者有淋巴结分期下降（p = 0.007）。当用MammaPrint和BluePrint分类时，与HR+HER2-，gLuminal A肿瘤相比，有更多的gLuminal B，gHER2和gBasal肿瘤患者有淋巴结分期下降（p = 0.538，p < 0.001和p = 0.013，分别）。用于定义为MammaPrint与或不与BluePrint组合的基因型高危肿瘤的患者对NCT有更好的反应，并有更高的淋巴结分期下降的可能性，与gLuminal A肿瘤的患者相比。这些基因组特征可以用于选择更有可能有淋巴结分期下降并避免侵入性手术的淋巴结阳性患者。© 2023. 作者（们）。

Neoadjuvant chemotherapy (NCT) increases the feasibility of surgical resection by downstaging large primary breast tumors and nodal involvement, which may result in surgical de-escalation and improved outcomes. This subanalysis from the Multi-Institutional Neo-adjuvant Therapy MammaPrint Project I (MINT) trial evaluated the association between MammaPrint and BluePrint with nodal downstaging.The prospective MINT trial (NCT01501487) enrolled 387 patients between 2011 and 2016 aged ≥ 18 years with invasive breast cancer (T2-T4). This subanalysis includes 146 patients with stage II-III, lymph node positive, who received NCT. MammaPrint stratifies tumors as having a Low Risk or High Risk of distant metastasis. Together with MammaPrint, BluePrint genomically (g) categorizes tumors as gLuminal A, gLuminal B, gHER2, or gBasal.Overall, 45.2% (n = 66/146) of patients had complete nodal downstaging, of whom 60.6% (n = 40/66) achieved a pathologic complete response. MammaPrint and combined MammaPrint and BluePrint were significantly associated with nodal downstaging (p = 0.007 and p < 0.001, respectively). A greater proportion of patients with MammaPrint High Risk tumors had nodal downstaging compared with Low Risk (p = 0.007). When classified with MammaPrint and BluePrint, more patients with gLuminal B, gHER2, and gBasal tumors had nodal downstaging compared with HR+HER2-, gLuminal A tumors (p = 0.538, p < 0.001, and p = 0.013, respectively).Patients with genomically High Risk tumors, defined by MammaPrint with or without BluePrint, respond better to NCT and have a higher likelihood of nodal downstaging compared with patients with gLuminal A tumors. These genomic signatures can be used to select node-positive patients who are more likely to have nodal downstaging and avoid invasive surgical procedures.© 2023. The Author(s).