Guo Sanxing, Shi Yonggang, Lu Shuo, He Yujie, Jin Guangyi, Zhang Suzhi, Li Xingya
Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Cancer. 2020 Sep 23;11(22):6653-6662. doi: 10.7150/jca.44768. eCollection 2020.
: Taxane-based regimens that are frequently used in adjuvant chemotherapy in early triple-negative breast cancer (TNBC) include a three-drug regimen (TAC and AC-T) and a two-drug regimen (TA and TC). Whether pathological lymph node stage guides taxane-based de-escalating chemotherapies in TNBC in adjuvant setting is still unclear. : We retrospectively examined 381 patients with early TNBC over a median follow-up period of 75.9 months and compared the disease-free survival (DFS) and overall survival (OS) of patients who received adjuvant taxane-based three-drug chemotherapy and two-drug chemotherapy according to pathological lymph node stage (negative, pN0; 1-3 positive, pN1; 4-9 positive, pN2). : In 222 pN0 patients, the taxane-based three-drug regimen was not superior to the two-drug regimen. In 159 pN1-2 patients, the taxane-based three-drug regimen significantly improved DFS (5-year DFS rate, 78.2% vs. 46.9%; log-rank =0.0002) and OS (5-year OS rate, 90.7% vs. 64.3%; log-rank =0.0001) compared with the two-drug regimen. In a multivariable Cox regression analysis of pN1-2 patients, after adjustment for clinical characteristics, the taxane-based three-drug regimen significantly decreased the risk of recurrence (adjusted HR, 0.37; 95% CI, 0.22 to 0.64; =0.0004) and death (adjusted HR, 0.22; 95% CI, 0.10 to 0.48; =0.0001) compared with the two-drug regimen. : The taxane-based chemotherapy triplet is superior to the chemotherapy doublet in patients with one to nine positive lymph nodes but not node-negative TNBC in adjuvant setting. These data suggest that pathological lymph node stage leads to de-escalating chemotherapy strategies in operable TNBC patients.
在早期三阴性乳腺癌（TNBC）辅助化疗中常用的基于紫杉烷的方案包括三药方案（TAC和AC-T）和两药方案（TA和TC）。在辅助治疗中，病理淋巴结分期是否能指导TNBC中基于紫杉烷的降阶梯化疗仍不清楚。
我们回顾性研究了381例早期TNBC患者，中位随访期为75.9个月，并根据病理淋巴结分期（阴性，pN0；1 - 3个阳性，pN1；4 - 9个阳性，pN2）比较了接受辅助性基于紫杉烷的三药化疗和两药化疗患者的无病生存期（DFS）和总生存期（OS）。
在222例pN0患者中，基于紫杉烷的三药方案并不优于两药方案。在159例pN1 - 2患者中，与两药方案相比，基于紫杉烷的三药方案显著改善了DFS（5年DFS率，78.2%对46.9%；对数秩检验=0.0002）和OS（5年OS率，90.7%对64.3%；对数秩检验=0.0001）。在对pN1 - 2患者进行的多变量Cox回归分析中，在调整临床特征后，与两药方案相比，基于紫杉烷的三药方案显著降低了复发风险（调整后HR，0.37；95%CI，0.22至0.64；P =0.0004）和死亡风险（调整后HR，0.22；95%CI，0.10至0.48；P =0.0001）。
在辅助治疗中，对于有1至9个阳性淋巴结的患者，基于紫杉烷的三联化疗优于双联化疗，但对于淋巴结阴性的TNBC患者则不然。这些数据表明，病理淋巴结分期可指导可手术TNBC患者的降阶梯化疗策略。
