Wright Jean L, Saigal Kunal, Reis Isildinha M, Zhao Wei, Takita Cristiane, Ambros Tadeu, Saeed Ali M, Sujoy Victoria, Hurley Judith
*Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD Departments of †Radiation Oncology ‡Public Health Sciences ¶Pathology, University of Miami Miller School of Medicine §Sylvester Comprehensive Cancer Center, Biostatistics and Bioinformatics Core, University of Miami Miller School of Medicine ∥Department of Medicine, Division of Hematology and Oncology, University of Miami Miller School of Medicine, Miami, FL.
Am J Clin Oncol. 2017 Oct;40(5):490-497. doi: 10.1097/COC.0000000000000194.
We report clinical outcomes in patients treated with neoadjuvant endocrine therapy (NET) versus neoadjuvant cytotoxic chemotherapy (NCT) in a cohort of postmenopausal women with ER+, HER2- breast cancer.
We retrospectively reviewed 140 patients treated between May 1998 and September 2010 and collected patient, disease, and treatment characteristics, response to neoadjuvant therapy, and clinical outcome.
The median age was 59.5 years. Stage group: stage I 2.2%, stage II 26.8%, stage III 71%, the median tumor size 6 cm (range, 1.5 to 19 cm). Fifty-seven (40.7%) received NET and 83 (59.3%) NCT. One patient (1.8%) in the NET group and 7 (8.4%) in the NCT group had a pathologic complete response (P=0.142). The median follow-up was 48.1 months. Five-year cumulative incidence of locoregional recurrence (LRR) among the entire cohort was 4.1% (95% confidence interval [CI]: 1.5, 8.9), and any recurrence 25.3% (95% CI: 17.6, 33.6). There was no difference in cumulative incidence of LRR or overall recurrence between NET and NCT. On multivariate analysis adjusting for receipt of chemotherapy, presenting stage, and positive lymph nodes, the use of adjuvant radiation therapy was associated with decreased risk of LRR (hazard ratio [HR]=0.24, P=0.035), and ypN2 status with higher risk of LRR (HR=4.91, P=0.032). When the same multivariate model was fitted for any recurrence outcome, only ypN2 status was a significant predictor of overall recurrence (HR=3.02, P=0.005).
We have demonstrated equivalent locoregional and overall outcomes in patients receiving NET versus NCT in a cohort of postmenopausal women with locally advanced ER+HER2-tumors.
我们报告了在一组绝经后雌激素受体阳性（ER+）、人表皮生长因子受体2阴性（HER2-）乳腺癌患者中，接受新辅助内分泌治疗（NET）与新辅助细胞毒性化疗（NCT）的患者的临床结局。
我们回顾性分析了1998年5月至2010年9月期间接受治疗的140例患者，并收集了患者、疾病和治疗特征、对新辅助治疗的反应以及临床结局。
中位年龄为59.5岁。分期组：I期2.2%，II期26.8%，III期71%，中位肿瘤大小为6cm（范围1.5至19cm）。57例（40.7%）接受NET，83例（59.3%）接受NCT。NET组1例患者（1.8%）和NCT组7例患者（8.4%）达到病理完全缓解（P=0.142）。中位随访时间为48.1个月。整个队列中局部区域复发（LRR）的5年累积发生率为4.1%（95%置信区间[CI]：1.5，8.9），任何复发的累积发生率为25.3%（95%CI：17.6，33.6）。NET和NCT之间LRR或总体复发的累积发生率没有差异。在对化疗接受情况、初始分期和阳性淋巴结进行多因素分析调整后，辅助放疗的使用与LRR风险降低相关（风险比[HR]=0.24，P=0.035），ypN2状态与LRR风险较高相关（HR=4.91，P=0.032）。当对任何复发结局拟合相同的多因素模型时，只有ypN2状态是总体复发的显著预测因素（HR=3.02，P=0.005）。
我们已经证明，在一组患有局部晚期ER+HER2-肿瘤的绝经后女性患者中，接受NET与NCT的患者在局部区域和总体结局方面相当。
