Ruff Paul, Cubasch Herbert, Joffe Maureen, Rosenbaum Evan, Murugan Nivashni, Tsai Ming-Chih, Ayeni Oluwatosin, Crew Katherine D, Jacobson Judith S, Neugut Alfred I
Division of Medical Oncology, Department of Internal Medicine, University of the Witwatersrand, Faculty of Health Sciences.
Noncommunicable Diseases Research Division, Wits Health Consortium, University of the Witwatersrand, Faculty of Health Sciences.
Cancer Manag Res. 2018 Feb 9;10:279-286. doi: 10.2147/CMAR.S148317. eCollection 2018.
Neoadjuvant (primary) chemotherapy (NACT) is the standard of care for locally advanced breast cancer. It also allows for the short-term assessment of chemotherapy response; a pathological complete responses correspond to improved long-term breast cancer outcomes. In sub-Saharan Africa, many patients are diagnosed with large nonresectable tumors. We examined NACT use in breast cancer patients who visited public hospitals in Johannesburg, South Africa.
We assessed demographic characteristics, tumor stage and grade, hormone receptor status, and human immunodeficiency virus (HIV) status of female patients diagnosed with nonmetastatic invasive carcinoma of the breast at Chris Hani Baragwanath Academic Hospital between January 1, 2009, and December 31, 2011. The patients received neoadjuvant, adjuvant, or no chemotherapy. Trastuzumab was unavailable. We developed logistic regression models to analyze the factors associated with NACT receipt in these patients.
Of 554 women with nonmetastatic breast cancer, the median age at diagnosis was 52 years (range: 28-88 years). Only 5.8% of patients were diagnosed with stage I disease; 49.3% and 44.9% were diagnosed with stages II and III, respectively. Most patients had hormone-responsive tumors: luminal A, 38.1%; luminal B (human epidermal growth factor receptor 2 [HER2]-negative and high grade), 12.5%, and luminal B (HER2-positive any grade), 11.6%; 11.6% had a HER2-enriched tumor and 20.6% a triple-negative tumor. Eighty (14.4%) patients were HIV-positive. In total, 195 patients (35.2%) received NACT, 264 (47.7%) patients received adjuvant chemotherapy, and 95 patients (17.1%) received no chemotherapy, including 62 (11.2%) patients who received only hormonal therapy. Of patients receiving NACT, 125 (64.1%) were evaluable for clinical response. Eighty (64.0%) patients had a clinically significant response; 19 (15.2%) patients had a stable disease, and 26 (20.8%) patients had a progressive disease. Multivariate analysis showed age <40 years and disease stage to be independently associated with the receipt of NACT.
Most women receiving NACT with available response data showed a clinical benefit. Stage III disease at diagnosis and age <40 years were predictors of neoadjuvant versus adjuvant chemotherapy treatment.
新辅助（原发性）化疗（NACT）是局部晚期乳腺癌的标准治疗方法。它还允许对化疗反应进行短期评估；病理完全缓解对应于改善的长期乳腺癌预后。在撒哈拉以南非洲，许多患者被诊断患有无法切除的大肿瘤。我们研究了在南非约翰内斯堡公立医院就诊的乳腺癌患者中NACT的使用情况。
我们评估了2009年1月1日至2011年12月31日期间在克里斯·哈尼·巴拉干纳特学术医院被诊断为非转移性浸润性乳腺癌的女性患者的人口统计学特征、肿瘤分期和分级、激素受体状态以及人类免疫缺陷病毒（HIV）状态。这些患者接受了新辅助化疗、辅助化疗或未接受化疗。曲妥珠单抗无法获得。我们建立了逻辑回归模型来分析这些患者接受NACT的相关因素。
在554例非转移性乳腺癌女性患者中，诊断时的中位年龄为52岁（范围：28 - 88岁）。仅5.8%的患者被诊断为I期疾病；49.3%和44.9%的患者分别被诊断为II期和III期。大多数患者患有激素反应性肿瘤：管腔A型，38.1%；管腔B型（人表皮生长因子受体2 [HER2]阴性且高级别），12.5%，以及管腔B型（HER2阳性任何级别），11.6%；11.6%的患者患有HER2富集型肿瘤，20.6%的患者患有三阴性肿瘤。80例（14.4%）患者HIV呈阳性。总共195例患者（35.2%）接受了NACT，264例（47.7%）患者接受了辅助化疗，95例患者（17.1%）未接受化疗，其中62例（11.2%）患者仅接受了激素治疗。在接受NACT的患者中，125例（64.1%）可评估临床反应。80例（64.0%）患者有临床显著反应；19例（15.2%）患者病情稳定，26例（20.8%）患者病情进展。多因素分析显示年龄<40岁和疾病分期与接受NACT独立相关。
大多数接受NACT且有可用反应数据的女性显示出临床获益。诊断时为III期疾病和年龄<40岁是新辅助化疗与辅助化疗治疗的预测因素。
