Puig Carlos A, Hoskin Tanya L, Day Courtney N, Habermann Elizabeth B, Boughey Judy C
Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2017 May;24(5):1242-1250. doi: 10.1245/s10434-016-5733-y. Epub 2016 Dec 20.
Neoadjuvant chemotherapy (NAC) downstages tumor size and nodal disease. This study evaluates national practice patterns of NAC use in hormone receptor-negative breast cancer.
We identified patients in the National Cancer Data Base (NCDB) with hormone receptor-negative invasive breast cancer (2004-2012). Univariate and multivariable logistic regression was used to assess associations and trends across time.
Of 171,985 patients, 130,723 (76.0%) received chemotherapy and 41,262 (24.0%) did not. Chemotherapy use was higher in young patients and higher T- and N-stage disease (all p < 0.001). Of those patients treated with chemotherapy, 23,165 (17.7%) received NAC and 107,558 (82.3%) received adjuvant chemotherapy (AC). NAC use increased from 2004 to 2012 (13.0-23.5%; adjusted odds ratio [aOR] 1.42; p < 0.001). Higher clinical T stage (ORs 3.63, 11.81, and 22.34 for cT2, cT3, and cT4a-c, respectively, vs. cT1) and cN+ disease (OR 2.86) [each p < 0.001] were associated with NAC, as were younger patient age and better Charlson-Deyo comorbidity score. Furthermore, BCS rate was higher in the NAC group in cT2 and cT3 tumors (aOR 1.17 and 1.45, respectively; both p < 0.001). In patients with cN+ disease, NAC converted 43.7% to pN0. Less extensive axillary surgery (one to five nodes removed) was more likely in cN+ patients treated with NAC (aOR 1.66; p < 0.001).
In hormone receptor-negative breast cancer, chemotherapy was mostly administered adjuvantly, but neoadjuvant use increased over time and was more likely in younger patients and higher T- and N-stage disease. Node-positive patients treated with NAC were less likely to have pathologically positive nodes and more likely to have less extensive axillary surgery.
新辅助化疗（NAC）可缩小肿瘤大小并降低淋巴结疾病分期。本研究评估了激素受体阴性乳腺癌患者使用NAC的全国实践模式。
我们在国家癌症数据库（NCDB）中识别出患有激素受体阴性浸润性乳腺癌的患者（2004 - 2012年）。采用单因素和多因素逻辑回归分析来评估不同时间的关联和趋势。
在171,985例患者中，130,723例（76.0%）接受了化疗，41,262例（24.0%）未接受化疗。年轻患者以及T分期和N分期较高的疾病患者化疗使用率更高（所有p < 0.001）。在接受化疗的患者中，23,165例（17.7%）接受了NAC，107,558例（82.3%）接受了辅助化疗（AC）。2004年至2012年期间NAC的使用有所增加（从13.0%增至23.5%；调整优势比[aOR]为1.42；p < 0.001）。较高的临床T分期（cT2、cT3和cT4a - c期相对于cT1期的OR分别为3.63、11.81和22.34）和cN +疾病（OR为2.86）[各p < 0.001]与NAC使用相关，年轻患者年龄和较好的Charlson - Deyo合并症评分也与之相关。此外，在cT2和cT3肿瘤中，NAC组的保乳手术（BCS）率更高（aOR分别为1.17和1.45；均p < 0.001）。在cN +疾病患者中，NAC使43.7%的患者转为pN0。接受NAC治疗的cN +患者更有可能进行范围较小的腋窝手术（切除1至5个淋巴结）（aOR为1.66；p < 0.001）。
在激素受体阴性乳腺癌中，化疗大多为辅助性使用，但新辅助使用随时间增加，且在年轻患者以及T分期和N分期较高的疾病患者中更有可能使用。接受NAC治疗的淋巴结阳性患者病理检查为阳性淋巴结的可能性较小，且进行范围较小的腋窝手术的可能性更大。
