Yu Ke-Da, Fan Lei, Qiu Li-Xin, Ling Hong, Jiang Yi-Zhou, Shao Zhi-Ming
Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
Department of Medical Oncology, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
Oncotarget. 2017 Jul 11;8(28):46549-46556. doi: 10.18632/oncotarget.10551.
The optimal time from surgery to initiation of adjuvant chemotherapy of breast cancer is still controversial. We investigated the influence of time to adjuvant chemotherapy on survival outcomes according to breast cancer subtype.
Longer delay of initiation of adjuvant chemotherapy (≤4 weeks versus >8 weeks)) significantly decreased the DFS (adjusted hazard ratio [HR] of 1.86; 95% confidence interval [CI], 1.19-2.90) and OS (adjusted HR of 2.02; 95% CI, 1.10-3.71). However, a moderate delay (≤4 weeks versus 4-8 weeks) did not significantly influence the survival. We further investigated the effect of time to adjuvant chemotherapy (≤8 versus >8 weeks) on survival according to subtypes. Patients with luminal-A tumors who received delayed chemotherapy had no increased risk of recurrence (HR of 1.15; 95% CI, 0.54-2.43). In contrast, patients with luminal-B, triple-negative, or trastuzumab-untreated HER2-positive tumors would have decreased DFS because of delayed chemotherapy, with HR of 1.93 (95% CI, 1.10-3.34), 2.55 (95% CI, 1.25-5.18), and 2.41 (95% CI, 1.36-4.26), respectively.
Operable women with stage I-IIIa breast cancer between 2003 and 2006 in our institution were included. 1,408 patients were divided into 3 groups according to the time to adjuvant chemotherapy: ≤4 weeks, 4-8 weeks, and >8 weeks. Disease-free survival (DFS) and overall survival (OS) were calculated.
Longer delay of adjuvant chemotherapy was associated with worse survival and early initiation of adjuvant chemotherapy should be performed for patients with aggressive tumor subtypes.
乳腺癌手术至辅助化疗开始的最佳时间仍存在争议。我们根据乳腺癌亚型研究了辅助化疗时间对生存结果的影响。
辅助化疗开始延迟时间较长（≤4周与>8周）显著降低了无病生存期（调整后风险比[HR]为1.86；95%置信区间[CI]，1.19 - 2.90）和总生存期（调整后HR为2.02；95%CI，1.10 - 3.71）。然而，中度延迟（≤4周与4 - 8周）对生存没有显著影响。我们进一步根据亚型研究了辅助化疗时间（≤8周与>8周）对生存的影响。接受延迟化疗的腔面A型肿瘤患者复发风险没有增加（HR为1.15；95%CI，0.54 - 2.43）。相比之下，腔面B型、三阴性或未接受曲妥珠单抗治疗的HER2阳性肿瘤患者由于延迟化疗无病生存期会降低，HR分别为1.93（95%CI，1.10 - 3.34）、2.55（95%CI，1.25 - 5.18）和2.41（95%CI，1.36 - 4.26）。
纳入2003年至2006年在我们机构就诊的I - IIIa期可手术乳腺癌女性患者。1408例患者根据辅助化疗时间分为3组：≤4周、4 - 8周和>8周。计算无病生存期（DFS）和总生存期（OS）。
辅助化疗延迟时间较长与较差的生存相关，对于侵袭性肿瘤亚型患者应尽早开始辅助化疗。
