Yale Cancer Center, Yale New Haven Hospital, 20 York Street, Ste North Pavilion 1, New Haven, CT, 06510, USA.
Yale COPPER, Harkness Office Building, 367 Cedar Street, New Haven, CT, 06510, USA.
Breast Cancer Res Treat. 2019 Nov;178(2):419-426. doi: 10.1007/s10549-019-05397-4. Epub 2019 Aug 10.
To evaluate if real-world utilization of neoadjuvant endocrine therapy (NET) is associated with similar rates of response and breast conservation surgery (BCS) compared to neoadjuvant chemotherapy (NAC).
Our population-based assessment used the National Cancer Data Base to identify women diagnosed with stage II-III, hormone receptor (HR)-positive BC who underwent surgery and received endocrine therapy from 2004 to 2014. Women were categorized by receipt of NET, NAC or no neoadjuvant therapy. We used logistic regression to assess differences in outcomes between therapies using inverse propensity score weighting to adjust for potential selection bias.
In our sample of 211,986 women, 6584 received NET, 52,310 received NAC, and 153,092 did not receive any neoadjuvant therapy. After adjusting for multiple relevant covariates and cofounders, there was no significant difference between NET and NAC with regard to BCS [odds ratio (OR) 0.91; 95% confidence interval (CI) (0.82-1.01)]; however, women who received NET were significantly less likely to achieve pCR [OR 0.34; 95% CI (0.23-0.51)] or a decrease in T stage [OR 0.39; CI (0.34-0.44)] compared to women treated with NAC. Patients who received NET for ≥ 3 months had higher odds of BCS (OR 1.59; 95% CI 1.46-1.73) and downstaging (OR 1.79; 95% CI 1.63-1.97) compared to patients who did not receive neoadjuvant therapy.
Women who received NET had similar rates of BCS compared to women who received NAC. Those who received NET for longer treatment durations had increased odds of BCS and downstaging compared to women who did not receive neoadjuvant therapy.
评估新辅助内分泌治疗（NET）的真实世界应用是否与新辅助化疗（NAC）相比具有相似的反应率和保乳手术（BCS）率。
我们的基于人群的评估使用国家癌症数据库，确定了 2004 年至 2014 年间接受手术和内分泌治疗且诊断为 II 期-III 期激素受体（HR）阳性乳腺癌的女性。根据接受 NET、NAC 或无新辅助治疗，将女性分为不同组别。我们使用逻辑回归评估治疗方法之间的差异，使用逆倾向评分加权法来调整潜在的选择偏倚。
在我们的 211986 名女性样本中，6584 名接受 NET，52310 名接受 NAC，153092 名未接受任何新辅助治疗。调整了多个相关协变量和混杂因素后，NET 与 NAC 在 BCS 方面没有显著差异[比值比（OR）0.91；95%置信区间（CI）（0.82-1.01）]；然而，与接受 NAC 治疗的女性相比，接受 NET 的女性 pCR 率[OR 0.34；95% CI（0.23-0.51）]或 T 分期降低[OR 0.39；CI（0.34-0.44）]的可能性明显较低。接受 NET 治疗≥3 个月的患者接受 BCS 的可能性更高（OR 1.59；95% CI 1.46-1.73）和降期（OR 1.79；95% CI 1.63-1.97）的可能性更高，与未接受新辅助治疗的患者相比。
接受 NET 的女性与接受 NAC 的女性相比，BCS 率相似。与未接受新辅助治疗的女性相比，接受 NET 治疗时间更长的女性接受 BCS 和降期的可能性更高。
