Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2012 Jan;19(1):253-8. doi: 10.1245/s10434-011-1877-y. Epub 2011 Jul 2.
Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer that is known to be chemosensitive. In patients with TNBC, we sought to compare survival outcomes between patients receiving neoadjuvant chemotherapy, with and without complete pathologic response (pCR), and those receiving adjuvant chemotherapy.
We performed a retrospective chart review and identified 385 patients with stage I-III TNBC who were treated with neoadjuvant or adjuvant chemotherapy between 2000 and 2008. Patients were divided according to receipt of neoadjuvant chemotherapy with pCR, neoadjuvant chemotherapy without pCR, and adjuvant chemotherapy. Data were compared using Fisher's exact test and analysis of variance (ANOVA). Kaplan-Meier curves were generated.
Of 385 patients, 151 (39%) received neoadjuvant chemotherapy and 234 (61%) received adjuvant chemotherapy. Twenty-six (17%) of those patients receiving neoadjuvant chemotherapy had pCR. After controlling for covariates associated with survival in unadjusted tests, patients undergoing neoadjuvant chemotherapy with residual tumor had significantly worse survival compared with patients receiving adjuvant therapy [hazard ratio (HR) = 0.51, P = 0.007] and a trend towards worse survival compared with patients receiving neoadjuvant therapy with pCR (HR = 0.19, P = 0.10).
Although previous clinical trials have not demonstrated a survival difference between patients receiving neoadjuvant versus adjuvant chemotherapy for breast cancer, our study suggests an overall survival benefit in patients with pCR following neoadjuvant chemotherapy compared with patients receiving adjuvant therapy. It is clear that a prospective study needs to be carried out to better elucidate the timing of chemotherapy in patients with TNBC.
三阴性乳腺癌（TNBC）是一种侵袭性乳腺癌亚型，已知对化疗敏感。在 TNBC 患者中，我们比较了接受新辅助化疗且有完全病理缓解（pCR）和无 pCR 与接受辅助化疗患者的生存结局。
我们进行了回顾性图表审查，确定了 385 例接受新辅助或辅助化疗治疗的 I-III 期 TNBC 患者，这些患者接受化疗的时间为 2000 年至 2008 年。根据接受新辅助化疗伴 pCR、新辅助化疗无 pCR 和辅助化疗，患者被分为不同组。采用 Fisher 确切检验和方差分析（ANOVA）比较数据。生成 Kaplan-Meier 曲线。
在 385 例患者中，151 例（39%）接受新辅助化疗，234 例（61%）接受辅助化疗。26 例（17%）接受新辅助化疗的患者有 pCR。在调整未调整检验中与生存相关的协变量后，与接受辅助治疗的患者相比，残留肿瘤接受新辅助化疗的患者生存显著更差（风险比[HR] = 0.51，P = 0.007），且与接受新辅助化疗伴 pCR 的患者相比生存趋势更差（HR = 0.19，P = 0.10）。
尽管之前的临床试验并未显示接受新辅助化疗与辅助化疗的乳腺癌患者生存存在差异，但我们的研究表明，与接受辅助治疗的患者相比，新辅助化疗后有 pCR 的患者的总体生存获益。显然，需要进行前瞻性研究以更好地阐明 TNBC 患者化疗的时机。
