J Natl Compr Canc Netw. 2018 Jul;16(7):845-850. doi: 10.6004/jnccn.2018.7022.
We sought to evaluate whether pathologic nodal response was predictive of outcomes in women aged ≤40 years with breast cancer treated with neoadjuvant chemotherapy (NAC). A total of 220 patients treated with NAC between 1991 and 2015 were retrospectively reviewed. Pathologic complete response (pCR) was defined as no evidence of residual invasive tumor in the breast and lymph nodes (LNs) (ypT0/Tis ypN0); partial response if there was no tumor in the LNs but residual tumor in the breast (ypT+ ypN0) or residual tumor in the LNs (ypT0/Tis ypN+); and limited response if there was residual tumor in both the breast and the LNs (ypT+ ypN+). Kaplan-Meier and Cox proportional hazards analyses were performed to identify factors predictive for overall survival (OS). A total of 155 patients were included. Following NAC, 39 patients (25.2%) achieved pCR, 57 (36.8%) achieved a partial response (either ypT+ ypN0 or ypT0/Tis ypN+), and 59 (38.1%) had a limited response. A total of 22 patients (14.2%) experienced local failure, 20 (12.9%) experienced regional failure, and 59 (38.1%) experienced distant failure. Median OS for patients who achieved pCR was not reached, and was significantly worse for patients who had residual disease in the breast and/or LNs (<.001). No difference in OS was seen among patients who had residual disease in the breast alone versus those who remained LN-positive (97 vs 83 months, respectively; =.25). Subset analysis did not reveal differences in OS based on year of treatment or cN1 disease at the time of initial diagnosis. Women aged ≤40 years who achieved pCR had excellent outcomes; however, those who achieved a pathologic response in the LNs but had residual disease in the breast continued to have outcomes similar to those who remained LN-positive.
我们旨在评估病理淋巴结反应是否可预测接受新辅助化疗 (NAC) 治疗的≤40 岁女性乳腺癌患者的结局。回顾性分析了 1991 年至 2015 年间接受 NAC 治疗的 220 例患者。病理完全缓解 (pCR) 定义为乳腺和淋巴结 (LNs) 中无残留浸润性肿瘤 (ypT0/Tis ypN0)；部分缓解指 LNs 中无肿瘤但乳腺中有残留肿瘤 (ypT+ypN0) 或 LNs 中有残留肿瘤 (ypT0/Tis ypN+)；有限缓解指乳腺和 LNs 中均有残留肿瘤 (ypT+ypN+)。采用 Kaplan-Meier 和 Cox 比例风险分析确定总生存 (OS) 的预测因素。共纳入 155 例患者。NAC 后，39 例 (25.2%) 达到 pCR，57 例 (36.8%) 达到部分缓解 (ypT+ypN0 或 ypT0/Tis ypN+)，59 例 (38.1%) 达到有限缓解。22 例 (14.2%) 发生局部失败，20 例 (12.9%) 发生区域失败，59 例 (38.1%) 发生远处失败。达到 pCR 的患者中位 OS 未达到，而乳腺和/或 LNs 仍有疾病的患者 OS 明显更差 (<.001)。乳腺有残留疾病与 LNs 仍阳性的患者 OS 无差异 (97 与 83 个月，分别；=.25)。亚组分析未发现基于治疗年份或初始诊断时 cN1 疾病的 OS 差异。达到 pCR 的≤40 岁女性患者结局极佳；然而，在 LNs 中达到病理缓解但乳腺有残留疾病的患者结局仍与 LNs 仍阳性的患者相似。
