Hennigs A, Riedel F, Marmé F, Sinn P, Lindel K, Gondos A, Smetanay K, Golatta M, Sohn C, Schuetz F, Heil J, Schneeweiss A
Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
Breast Cancer Res Treat. 2016 Dec;160(3):491-499. doi: 10.1007/s10549-016-4016-4. Epub 2016 Oct 15.
During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units.
This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014.
Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %.
The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control.
在过去十年中，早期乳腺癌（EBC）的新辅助化疗（NACT）已从旨在实现可手术性的治疗方法演变为一种标准治疗选择，旨在提高治愈率，使其与辅助化疗（ACT）相当。与此同时，专业乳腺护理单位已建立了乳腺癌护理质量控制的改进措施。
本研究分析了2003年1月至2014年12月在海德堡大学乳腺科接受治疗的EBC患者的化疗使用情况。
总体而言，5703例患者纳入分析，其中2222例（39%）接受化疗，817例（37%）接受NACT，1405例（63%）接受ACT。该队列的化疗使用率从2003年的48%降至2014年的34%。此外，无论肿瘤亚型如何，NACT的比例从42%升至65%。另外，NACT后手术时定义为乳腺和腋窝无肿瘤残留（ypT0 ypN0）的病理完全缓解（pCR）频率从2003年的12%增至2014年的35%。在HER2+乳腺癌中观察到最大效果，达到pCR的患者从24%增至68%。
结果反映了德国EBC化疗适应证的细化及其作为NACT的首选使用情况。随着时间推移pCR率的增加表明，通过多学科决策过程和严格的质量控制措施，治疗结果得到了改善。
