Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru.
Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru.
Clin Breast Cancer. 2021 Jun;21(3):239-246.e4. doi: 10.1016/j.clbc.2020.09.008. Epub 2020 Sep 18.
Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC.
We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors.
In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively).
A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.
辅助化疗可降低复发风险并提高生存率；然而，目前尚不清楚延迟开始化疗是否与不良预后相关，尤其是在三阴性乳腺癌（TNBC）中。本研究评估了 TNBC 患者开始辅助化疗时间（TTC）对结局的影响。
我们回顾性分析了在秘鲁利马的国立肿瘤研究所（Instituto Nacional de Enfermedades Neoplasicas）接受辅助化疗的 TNBC 患者 15 年的数据。将 TTC 分为 4 组：≤30、31-60、61-90 和≥91 天。我们评估了总生存（OS）和远处无复发生存率（DRFS）。采用 Cox 比例风险模型确定预后因素。
共纳入 687 例患者。诊断时的平均年龄为 49.1 岁（标准差，11.8 岁），大多数（62.6%）患者为病理分期 T2。中位 TTC 为 48.1 天（标准差，27.4 天）；189 例（27.5%）在 30 天内接受化疗；329 例（47.9%）在 31-60 天内接受化疗；115 例（16.7%）在 61-90 天内接受化疗；54 例（7.9%）在 91 天以上接受化疗。多变量分析显示，31-60 天（风险比 [HR]，1.78；95%置信区间 [CI]，1.17-2.72）、61-90 天（HR，2.38；95%CI，1.43-3.97）和≥91 天（HR，2.45；95%CI，1.32-4.55）的 TTC 与死亡率升高相关，而 TTC<30 天与之相反。尽管 31-60 天、61-90 天和≥91 天的 TTC 与 DRFS 风险增加相关（HR，1.86；95%CI，1.24-2.79；HR，2.34，95%CI，1.42-3.867；HR，3.16；95%CI，1.78-5.61）。
TTC≥30 天的延迟与较差的结局相关。我们的数据表明，应采取多种措施避免 TNBC 患者的 TTC 延迟。
