年龄对新辅助化疗后局部晚期乳腺癌病理完全缓解和局部区域复发的影响。
Impact of age on pathological complete response and locoregional recurrence in locally advanced breast cancer after neoadjuvant chemotherapy.
机构信息
Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Khartoum Breast Care Center, Khartoum, Sudan.
出版信息
Biomed J. 2019 Feb;42(1):66-74. doi: 10.1016/j.bj.2018.10.007. Epub 2019 Mar 28.
BACKGROUND
Neoadjuvant chemotherapy (NAC) is the standard approach for downstaging of locally advanced breast cancer and can improve breast conservation rates. A pathological complete response (pCR) after NAC associated with favorable long-term outcomes has been described. There is still a high locoregional recurrence (LRR) rate after NAC and the influence of age on LRR after NAC is unclear. This study analyzed the relationship between age and LRR after NAC.
METHODS
Two hundred and sixty-three patients with invasive breast cancer who received NAC followed by mastectomy or breast conserving surgery (BCS) were enrolled. Concurrent weekly epirubicin and docetaxel was the NAC regimen.
RESULTS
Twenty-nine patients (11%) achieved a pCR after NAC. In univariate analysis, age <50 years, luminal B (HER2 positive) subtype, HER2 overexpression subtype, and triple-negative subtype were factors to predict a pCR. In multivariate analysis, age <50 years, luminal B (HER2 positive) type, HER2 overexpression, and triple-negative subtype were the independent factors to predict a pCR. No patients in the pCR group developed LRR compared with 31 patients in the non-pCR group. Eleven patients (6.9%) in the younger group (age <50 years) developed LRR compared with 20 patients (19.4%) in the older group (age ≥50 years). In multivariate analysis, younger age (<50 years) was the only independent prognostic factor for a LRR-free survival.
CONCLUSION
Younger age can predict a pCR and is an independent prognostic factor for LRR in locally advanced breast cancer patients after NAC as concurrent epirubicin and docetaxel.
背景
新辅助化疗（NAC）是局部晚期乳腺癌降期的标准方法，可提高保乳率。NAC 后病理完全缓解（pCR）与有利的长期结果相关已被描述。NAC 后仍有较高的局部区域复发（LRR）率，年龄对 NAC 后 LRR 的影响尚不清楚。本研究分析了年龄与 NAC 后 LRR 的关系。
方法
纳入 263 例接受 NAC 后行乳房切除术或保乳手术（BCS）的浸润性乳腺癌患者。NAC 方案为表柔比星和多西他赛联合化疗。
结果
29 例（11%）患者 NAC 后达到 pCR。单因素分析显示，年龄<50 岁、Luminal B（HER2 阳性）型、HER2 过表达型和三阴性型是预测 pCR 的因素。多因素分析显示，年龄<50 岁、Luminal B（HER2 阳性）型、HER2 过表达型和三阴性型是预测 pCR 的独立因素。pCR 组无患者发生 LRR，而非 pCR 组有 31 例患者发生 LRR。年轻组（年龄<50 岁）有 11 例（6.9%）患者发生 LRR，而老年组（年龄≥50 岁）有 20 例（19.4%）患者发生 LRR。多因素分析显示，年龄较轻（<50 岁）是 LRR 无复发生存的唯一独立预后因素。
结论
在接受表柔比星和多西他赛联合化疗的局部晚期乳腺癌患者中，年轻年龄（<50 岁）可预测 pCR，是 LRR 的独立预后因素。
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