Zhang Jiaqiang, Sun Mingyang, Chang Enqiang, Lu Chang-Yun, Chen Ho-Min, Wu Szu-Yuan
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University Zhengzhou, Henan, China.
Department of General Surgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital Yilan, Taiwan.
Am J Cancer Res. 2020 Oct 1;10(10):3415-3427. eCollection 2020.
To determine easy-to-use predictors of overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM) in breast invasive ductal carcinoma (IDC) patients receiving neoadjuvant chemotherapy (NACT) and total mastectomy (TM), we used the pathologic response (PR) of primary breast diseases (T stages), nodal diseases (N stages), and combined primary and nodal diseases (American Joint Committee on Cancer [AJCC] stages) based on existing clinical and pathologic reports as predictors. We enrolled patients with IDC who received NACT followed by TM. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs) of PR; other independent predictors were controlled for or stratified in the analysis. We analyzed 3654 IDC patients (1031, 1215, 1003, and 405 patients with clinical stages IIB, IIIA, IIIB, and IIIC, respectively) receiving NACT and TM. After multivariate Cox regression analyses, the adjusted HRs (aHRs) (95% CI) for all-cause mortality, LRR, and DM were noted to be 0.21 (0.13-0.34), 0.19 (0.08-0.48), and 0.33 (0.23-0.47), respectively, for pCR; 0.56 (0.48-0.65), 0.67 (0.51-0.89), and 0.61 (0.52-0.70), respectively, for AJCC downstaging; and 1.85 (1.56-2.18), 1.17 (0.84-1.62), and 1.61 (1.36-1.90), respectively, for AJCC upstaging. The PR parameters used in the study are easily applied because they are based on existing staging records, and they can strongly predict OS, LRR, and DM in IDC patients receiving NACT and TM, regardless of clinical stage. The results can be used to guide adjuvant treatment.
为了确定接受新辅助化疗（NACT）和全乳切除术（TM）的乳腺浸润性导管癌（IDC）患者总生存期（OS）、局部区域复发（LRR）和远处转移（DM）的易用预测指标，我们将基于现有临床和病理报告的原发性乳腺疾病（T分期）、淋巴结疾病（N分期）以及原发性和淋巴结疾病联合（美国癌症联合委员会[AJCC]分期）的病理反应（PR）用作预测指标。我们纳入了接受NACT后行TM的IDC患者。采用Cox回归分析计算PR的风险比（HRs）和置信区间（CIs）；分析中对其他独立预测指标进行了控制或分层。我们分析了3654例接受NACT和TM的IDC患者（分别有1031、1215、1003和405例临床分期为IIB、IIIA、IIIB和IIIC期的患者）。经过多因素Cox回归分析，pCR患者全因死亡率、LRR和DM的校正HRs（aHRs）（95%CI）分别为0.21（0.13 - 0.34）、0.19（0.08 - 0.48）和0.33（0.23 - 0.47）；AJCC分期降期患者分别为0.56（0.48 - 0.65）、0.67（0.51 - 0.89）和0.61（0.52 - 0.70）；AJCC分期升期患者分别为1.85（1.56 - 2.18）、1.17（0.84 - 1.62）和1.61（1.36 - 1.90）。本研究中使用的PR参数易于应用，因为它们基于现有的分期记录，可以强有力地预测接受NACT和TM的IDC患者的OS、LRR和DM，而不受临床分期的影响。这些结果可用于指导辅助治疗。
