真实世界评估新辅助化疗后三阴性乳腺癌肿瘤大小对病理完全缓解率的影响。

Real-world assessment of the effect of impact of tumor size on pathological complete response rates in triple negative breast cancer after neoadjuvant chemotherapy.

机构信息

Breast Cancer Research Unit, Clinical Research Division, Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil.

Cancer Research UK, Cambridge Institute, University of Cambridge, Garvan Institute of Medical Research, Sydney, Australia.

出版信息

Chin Clin Oncol. 2020 Dec;9(6):78. doi: 10.21037/cco-20-111. Epub 2020 Nov 10.

DOI:10.21037/cco-20-111

PMID:33183012

Abstract

BACKGROUND

Triple negative breast cancer (TNBC) is characterized rapid tumor growth, and increased metastatic potential compared to other breast cancer subtypes. However, pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) can predict patients with a better prognosis. Clinical predictors of pCR such as tumor size (TS) are controversial. This study aims to evaluate the influence of TS on achieving pCR, and the associated survival outcomes.

METHODS

Medical records from 310 TNBC patients treated with NACT between 2010 and 2013 in National Cancer Institute Brazil were screened. The aim study was to examine the impact of TS on pCR. We used descriptive statistics to organize and summarize TS data and all the other variables of interest. Logistic regression has done to assess if any of these variables were associated with pCR. Survival data were extrapolated using Kaplan-Meier analysis and log-rank tests.

RESULTS

Thirty-nine (21%) of 187 enrolled patients achieved pCR. Median age was 48 years, 50.27% were postmenopausal, 93.03% T3/T4 and 75.39% axillar clinical node-positive; 92.51% received an anthracycline regimen followed by a taxane. Age >40 years (P=0.04, OR 0.45, 95% CI, 0.20-0.95) and tumor infiltrating lymphocytes (TILs) presence (P<0.01, OR 3.71, 95% CI, 1.60-8.60) were factors significantly associated with increased rates of pCR. Neither the TS (IQR: 4; P=0.22, OR 0.93, 95% CI, 0.83-1.03) nor the other subgroups analysed demonstrated any association with achieving pCR. Median follow-up was 36 months. The 5-year OS and RFS of the study population was 71.20% and 61.10% respectively.

CONCLUSIONS

Preoperative TS did not significantly impact pCR rate in our cohort of patients receiving NACT for TNBC. Characteristics associated with higher pCR rate included TILs and age >40 years. In addition, pCR, was indicative of better survival outcomes.

摘要

背景

与其他乳腺癌亚型相比，三阴性乳腺癌（TNBC）的特点是肿瘤生长迅速，转移潜能增加。然而，新辅助化疗（NACT）的病理完全缓解（pCR）可以预测患者的预后较好。肿瘤大小（TS）等临床预测因素存在争议。本研究旨在评估 TS 对获得 pCR 的影响及其相关生存结局。

方法

筛选了 2010 年至 2013 年在巴西国家癌症研究所接受 NACT 治疗的 310 例 TNBC 患者的病历。本研究旨在研究 TS 对 pCR 的影响。我们使用描述性统计来组织和总结 TS 数据和所有其他感兴趣的变量。采用 logistic 回归评估这些变量中是否有任何一个与 pCR 相关。使用 Kaplan-Meier 分析和对数秩检验推断生存数据。

结果

39 例（21%）187 例入组患者达到 pCR。中位年龄为 48 岁，50.27%绝经后，93.03% T3/T4 和 75.39%腋窝临床淋巴结阳性；92.51%接受蒽环类药物联合紫杉烷方案。年龄>40 岁（P=0.04，OR 0.45，95%CI，0.20-0.95）和肿瘤浸润淋巴细胞（TILs）存在（P<0.01，OR 3.71，95%CI，1.60-8.60）是与 pCR 率增加相关的因素。TS（IQR：4；P=0.22，OR 0.93，95%CI，0.83-1.03）和其他亚组分析均与获得 pCR 无关。中位随访时间为 36 个月。该研究人群的 5 年 OS 和 RFS 分别为 71.20%和 61.10%。