Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Surg Res. 2010 Sep;163(1):52-7. doi: 10.1016/j.jss.2010.04.015. Epub 2010 May 6.
The study aim was to investigate factors that predict the use of neoadjuvant versus adjuvant chemotherapy in patients with triple negative breast cancer (TNBC) and the overall survival in each group.
We identified 493 patients with Stage I-III TNBC between 1998 and 2008. Patients were divided according to receipt of neoadjuvant, adjuvant, or none/unknown chemotherapy. Data were compared using chi(2) and Fisher's exact test. For more than two group comparisons and analyzing multiple dependent variables, MANOVA was used. Kaplan-Meier curves were generated.
Of 493 patients with TNBC, 154 (31%) received neoadjuvant chemotherapy, 251 (51%) received adjuvant chemotherapy, and 88 (18%) had no or unknown chemotherapy. Patients undergoing neoadjuvant chemotherapy were younger (mean 50, range 20-83) compared with those undergoing adjuvant chemotherapy (mean 53, range 25-83) or none/unknown chemotherapy (mean 62, range 29-86) (P < 0.0001). The three groups did not differ significantly by patient race, tumor histology, or tumor grade. Increased tumor size, nodal positivity, and advanced stage were more likely to be associated with use of neoadjuvant chemotherapy (all comparisons P < 0.0001). After controlling for covariates associated with survival in unadjusted tests, patients undergoing adjuvant therapy were less likely to die compared with patients undergoing neoadjuvant therapy or none/unknown therapy (overall aHR 0.476, 95% CI 0.295-0.770).
Women with TNBC who underwent adjuvant chemotherapy were 52% less likely to die overall compared with those who received neoadjuvant chemotherapy or none/unknown chemotherapy in this institutional series. Prospective studies are necessary to determine if this finding is durable.
本研究旨在探讨预测三阴性乳腺癌（TNBC）患者接受新辅助化疗与辅助化疗的因素，以及两组患者的总生存率。
我们在 1998 年至 2008 年间确定了 493 例 I-III 期 TNBC 患者。根据接受新辅助化疗、辅助化疗或无/未知化疗将患者分组。使用卡方检验和 Fisher 精确检验比较数据。对于超过两组的比较和分析多个因变量，使用 MANOVA。生成 Kaplan-Meier 曲线。
在 493 例 TNBC 患者中，154 例（31%）接受新辅助化疗，251 例（51%）接受辅助化疗，88 例（18%）无或未知化疗。接受新辅助化疗的患者年龄更小（平均 50 岁，范围 20-83），与接受辅助化疗（平均 53 岁，范围 25-83）或无/未知化疗（平均 62 岁，范围 29-86）的患者相比（P<0.0001）。三组患者的种族、肿瘤组织学或肿瘤分级无显著差异。肿瘤大小增加、淋巴结阳性和晚期分期更可能与新辅助化疗的使用相关（所有比较 P<0.0001）。在未调整的生存测试中，控制与生存相关的协变量后，接受辅助治疗的患者与接受新辅助治疗或无/未知治疗的患者相比，死亡的可能性较小（总体 aHR 0.476，95%CI 0.295-0.770）。
在本机构系列中，接受辅助化疗的 TNBC 女性患者的总体死亡率比接受新辅助化疗或无/未知化疗的患者低 52%。需要前瞻性研究来确定这一发现是否持久。
