Mohiuddin Jahan J, Deal Allison M, Lund Jennifer L, Carey Lisa A, Baker Brock R, Zagar Timothy M, Jones Ellen L, Marks Lawrence B, Chen Ronald C
School of Medicine (JJM, BRB), Lineberger Comprehensive Cancer Center (AMD, JLL, LAC, TMZ, ELJ, LBM, RCC), Biostatistics Core Facility (AMD), Department of Epidemiology, Gillings School of Global Public Health (JLL), Division of Hematology-Oncology (LAC), Department of Radiation Oncology (TMZ, ELJ, LBM, RCC), Sheps Center for Health Services Research (RCC), University of North Carolina at Chapel Hill, Chapel Hill, NC.
JNCI Cancer Spectr. 2017 Sep 23;1(1):pkx004. doi: 10.1093/jncics/pkx004. eCollection 2017 Sep.
Neoadjuvant chemotherapy in breast cancer reduced mastectomy rates by 7% to 13% in randomized trials. However, the differential effects for women with different stages, receptor subtypes, and ages are unknown. We compared mastectomy rates in women who did vs did not receive neoadjuvant chemotherapy in 18 patient subgroups. The main objective was to quantify the potential benefit from neoadjuvant chemotherapy in reducing mastectomy rates for each subgroup.
Our retrospective analysis used data from the National Cancer Data Base, which includes approximately 70% of incident cancers across the United States. Absolute risk reductions for mastectomy were determined for 18 subgroups of clinical stage, receptor subtype, and age group. In each subgroup, propensity score weighting balanced measured covariates between women treated with vs without neoadjuvant chemotherapy.
A total of 55 709 patients were analyzed. In clinical stage IIA disease, only patients with human epidermal growth factor receptor 2 (HER2)-positive tumors had reduced mastectomy rates associated with neoadjuvant chemotherapy (age < 60 years, 12%; age ≥ 60 years, 12.6%). For stage IIB cancers, neoadjuvant chemotherapy was associated with an absolute reduction in mastectomy rates of 5.9% in women younger than age 60 years with hormone receptor-positive/HER2- disease, 8.2% to 10.7% for triple-negative disease, and 11.7% to 17.4% for HER2+ disease. For stage IIIA, the reductions in mastectomy rates ranged from 6.6% to 15.9%.
In an analysis of patients treated across the United States, we found that neoadjuvant chemotherapy was associated with a reduction in mastectomy rates to a similar magnitude overall as shown in randomized trials, but this benefit varied widely by patient subgroup. This study provides novel information to help women make informed decisions regarding treatment.
在随机试验中，乳腺癌新辅助化疗使乳房切除术率降低了7%至13%。然而，不同分期、受体亚型和年龄的女性所产生的差异影响尚不清楚。我们比较了18个患者亚组中接受和未接受新辅助化疗的女性的乳房切除术率。主要目的是量化新辅助化疗在降低每个亚组乳房切除术率方面的潜在益处。
我们的回顾性分析使用了来自国家癌症数据库的数据，该数据库涵盖了美国约70%的新发癌症病例。确定了临床分期、受体亚型和年龄组的18个亚组的乳房切除术绝对风险降低率。在每个亚组中，倾向评分加权平衡了接受和未接受新辅助化疗的女性之间的测量协变量。
共分析了55709例患者。在临床IIA期疾病中，只有人表皮生长因子受体2（HER2）阳性肿瘤的患者接受新辅助化疗后乳房切除术率降低（年龄<60岁，12%；年龄≥60岁，12.6%）。对于IIB期癌症，新辅助化疗使年龄小于60岁、激素受体阳性/HER2阴性疾病的女性乳房切除术率绝对降低5.9%，三阴性疾病降低8.2%至10.7%，HER2阳性疾病降低11.7%至17.4%。对于IIIA期，乳房切除术率降低幅度为6.6%至15.9%。
在一项对美国各地接受治疗的患者的分析中，我们发现新辅助化疗与乳房切除术率降低相关，总体幅度与随机试验中所示相似，但这种益处因患者亚组而异。本研究提供了新的信息，以帮助女性就治疗做出明智的决定。
