Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Breast J. 2010 Jan-Feb;16(1):9-13. doi: 10.1111/j.1524-4741.2009.00864.x. Epub 2009 Nov 19.
Neo-adjuvant chemotherapy enables us to increase the possibility of breast-conserving surgery for large, bulky tumors. However, several studies have reported that ipsilateral breast tumor recurrences (IBTRs) occur more frequently after neo-adjuvant chemotherapy than originally envisaged. Recently, it was demonstrated that clinical early response after neo-adjuvant chemotherapy predicts pathological complete response. In this study, we assessed the association of clinical early response after neo-adjuvant chemotherapy with successful breast-conserving surgery and IBTR risk. Between 1995 and 2002, 114 patients with T 3.1-6 cm, N 0 or 1, M 0 breast cancer who were candidates for mastectomy but desired breast-conserving surgery were treated with neo-adjuvant chemotherapy. After two cycles of anthracycline-based neo-adjuvant chemotherapy and before surgery, breast tumors were measured by palpation or ultrasound. Clinical response after two cycles of chemotherapy was defined as positive when the largest tumor dimension was reduced by 30% or greater. Median follow-up time was 72 months. After two cycles of neo-adjuvant chemotherapy, 54 (47.4%) of 114 patients achieved an early response. Patients with the early response underwent breast-conserving surgery significantly more frequently than those without the early response (78% versus 58%, p = 0.03). In addition, the early response was significantly correlated with selection of breast-conserving surgery (odds ratio 3.8, p = 0.01) after adjustments for various clinicopathological factors. Patients without the early response showed significantly lower 6-year IBTR-free survival than patients with the early response (75% versus 97%, p = 0.02). In addition, patients with the early response showed significantly higher 6-year disease-free survival rates than those with the early response (p = 0.02). Multivariate analysis showed that the early response was a predictive factor of IBTR-free survival, being independent of other clinicopathological factors. In conclusion, the early response to neo-adjuvant chemotherapy may be a useful predictor of both selection of surgical method and IBTR risk.
新辅助化疗使我们能够增加对大体积肿瘤进行保乳手术的可能性。然而，几项研究报告称，新辅助化疗后同侧乳房肿瘤复发（IBTR）的发生率高于最初预期。最近，研究表明新辅助化疗后的临床早期反应预测病理完全缓解。在这项研究中，我们评估了新辅助化疗后临床早期反应与成功保乳手术和 IBTR 风险的关系。1995 年至 2002 年间，114 例 T3.1-6cm、N0 或 1、M0 乳腺癌患者，适合行乳房切除术但希望行保乳手术，接受新辅助化疗。在两个周期的蒽环类新辅助化疗后且在手术前，通过触诊或超声测量乳房肿瘤。当最大肿瘤尺寸减少 30%或更多时，将化疗后两个周期的临床反应定义为阳性。中位随访时间为 72 个月。在两个周期的新辅助化疗后，114 例患者中有 54 例（47.4%）获得了早期反应。与无早期反应的患者相比，有早期反应的患者行保乳手术的频率显著更高（78%比 58%，p=0.03）。此外，在调整了各种临床病理因素后，早期反应与保乳手术的选择显著相关（优势比 3.8，p=0.01）。无早期反应的患者 6 年无同侧乳房肿瘤复发生存率显著低于有早期反应的患者（75%比 97%，p=0.02）。此外，有早期反应的患者 6 年无病生存率显著高于无早期反应的患者（p=0.02）。多变量分析显示，早期反应是无同侧乳房肿瘤复发生存率的预测因素，独立于其他临床病理因素。总之，新辅助化疗的早期反应可能是选择手术方法和同侧乳房肿瘤复发风险的有用预测指标。
