Present Address: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, China.
World J Surg Oncol. 2017 Nov 28;15(1):210. doi: 10.1186/s12957-017-1273-6.
With limited sample sizes and single-institution designs, how complete response (CR) after neoadjuvant chemotherapy (NAC) influences breast conserving surgery (BCS) and its value in prognosis are not clear.
A systematic research review was conducted using electronic database. The rate of clinical complete response (cCR) in BCS after NAC and these pathological CR (PCR) and non-pCR BCS patients' local recurrence-free survival (LRFS), distance recurrence-free survival (DRFS), overall survival (OS), and disease-free survival (DFS) rates were collected. A pooled analysis was performed using a fixed or random effects model and a Q test to determine heterogeneity.
Sixteen studies with a total of 4639 patients were included. The pooled data revealed that cCR patients compared with non-cCR patients had significantly higher rates of BCS, with a summary estimate odds ratios (OR) of 4.54 (95% CI 2.03-10.17). The pooled data revealed that BCS patients who achieved pCR after NAC had significantly lower rates of LRFS (RR = 0.59, 95% CI 0.38-0.92) and DRFS (RR = 0.27, 95% CI 0.13-0.55). Better DFS (RR = 0.09, 95% CI 0.04-0.25) and OS (RR = 0.36, 95% CI 0.03-3.90) were also seen, but OS was not significantly different.
The rate of successful BCS is higher in the cCR group than in the non-cCR group, means cCR after NAC can encourage patients to receive BCS. The achievement of pCR after NAC in BCS patients was associated with a good prognosis in terms of LRFS and DRFS, but its value in DFS and OS requires further investigation.
新辅助化疗（NAC）后完全缓解（CR）的比例较低，样本量有限且为单中心设计，因此尚不清楚 NAC 后保乳手术（BCS）的完全缓解率（CR）及其对预后的影响。
系统检索电子数据库，收集 NAC 后行 BCS 的临床完全缓解（cCR）率，以及这些病理完全缓解（PCR）和非 PCR 的 BCS 患者的局部无复发生存率（LRFS）、远处无复发生存率（DRFS）、总生存率（OS）和无病生存率（DFS）。采用固定或随机效应模型及 Q 检验进行合并分析，以评估异质性。
纳入 16 项研究，共 4639 例患者。汇总数据显示，cCR 患者行 BCS 的比例明显高于非 cCR 患者，汇总估计比值比（OR）为 4.54（95%可信区间 2.03-10.17）。此外，汇总数据还显示，NAC 后达到 pCR 的 BCS 患者 LRFS（RR=0.59，95%可信区间 0.38-0.92）和 DRFS（RR=0.27，95%可信区间 0.13-0.55）的复发率更低，DFS（RR=0.09，95%可信区间 0.04-0.25）和 OS（RR=0.36，95%可信区间 0.03-3.90）的生存情况更好，但 OS 无显著差异。
cCR 组患者行 BCS 的成功率高于非 cCR 组，这意味着 NAC 后 cCR 可鼓励患者接受 BCS。对于接受 BCS 的患者，NAC 后达到 pCR 与 LRFS 和 DRFS 的良好预后相关，但在 DFS 和 OS 方面的价值尚需进一步研究。
