Huang Liang, Chen Sheng, Yang Wentao T, Shao Zhiming
Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Oncotarget. 2017 Jun 13;8(24):39703-39710. doi: 10.18632/oncotarget.14407.
We seek to investigate the prognostic factors that could possibly increase the locoregional recurrence of breast cancer patients who do not achieve pathological complete response after neoadjuvant chemotherapy, and to build a prognostic nomogram to predict patients' outcome. The retrospective analysis included 510 patients who had received neoadjuvant chemotherapy followed by surgery and radiotherapy. 62 locoregional events occurred after a median 61 months of follow-up. The five-year cumulative incidence of local recurrence and regional recurrence were 8.63% and 4.31%, respectively. Multivariate analysis revealed that positivity for ≥ 4 lymph nodes and Ki-67 index ≥ 14% were independent factors. According to our prognostic model, the 5-year locoregional free survival rates in the low, intermediate, and high-risk groups were 95.5%, 89.1%, and 67.1%, respectively (p < 0.001). Annual recurrence curves indicated that the relapse peak after mastectomy emerged in the first 1 year. Positivity for ≥ 4 lymph nodes and Ki-67 index ≥ 14% were independent factors for locoregional recurrence. This prognostic model has considerable clinical value in predicting locoregional recurrence, which could help clinicians to design appropriate locoregional treatment specifically and to perform surveillance individually.
我们旨在研究可能增加新辅助化疗后未达到病理完全缓解的乳腺癌患者局部区域复发的预后因素，并构建一个预后列线图来预测患者的预后。这项回顾性分析纳入了510例接受新辅助化疗后行手术及放疗的患者。中位随访61个月后发生了62例局部区域事件。局部复发和区域复发的5年累积发生率分别为8.63%和4.31%。多因素分析显示，≥4枚淋巴结阳性和Ki-67指数≥14%是独立因素。根据我们的预后模型，低、中、高危组的5年局部区域无复发生存率分别为95.5%、89.1%和67.1%（p<0.001）。年度复发曲线表明，乳房切除术后的复发高峰出现在第1年。≥4枚淋巴结阳性和Ki-67指数≥14%是局部区域复发的独立因素。该预后模型在预测局部区域复发方面具有相当大的临床价值，有助于临床医生制定具体的合适局部区域治疗方案并进行个体化监测。
