Laas Enora, Bresset Arnaud, Féron Jean-Guillaume, Le Gal Claire, Darrigues Lauren, Coussy Florence, Grandal Beatriz, Laot Lucie, Pierga Jean-Yves, Reyal Fabien, Hamy Anne-Sophie
Department of Surgery, Institut Curie, 5 rue d'Ulm, 75005 Paris, France.
Gynecology Department, Beaujon Hospital, 92210 Clichy, France.
Cancers (Basel). 2021 Jan 20;13(3):370. doi: 10.3390/cancers13030370.
No survival benefit has yet been demonstrated for neoadjuvant chemotherapy (NAC) against -positive tumors in patients with early breast cancer (BC). The objective of this study was to compare the prognosis of -positive BC patients treated with NAC to that of patients treated with adjuvant chemotherapy (AC).
We retrospectively analyzed disease-free (DFS) and overall survival (OS) in 202 -positive patients treated with NAC and 701 patients treated with AC. All patients received trastuzumab in addition to chemotherapy. Patient data were weighted by a propensity score to overcome selection bias.
After inverse probability of treatment weights (IPTW) adjustment, no difference in DFS ( = 0.3) was found between treatments for the total population. However, after multivariate analysis, an interaction was found between cN status and chemotherapy strategy (IPTW-corrected corrected Hazard ratio cHR = 0.52, 95% CI (0.3-0.9), = 0.08) and between menopausal status and chemotherapy (CT) strategy (cHR = 0.35, 95%CI (0.18-0.7)) < 0.01). NAC was more beneficial than AC strategy in cN-positive patients and in postmenopausal patients. Moreover, after IPTW adjustment, the multivariate analysis showed that the neoadjuvant strategy conferred a significant OS benefit (cHR = 0.09, 95%CI [0.02-0.35], < 0.001).
In patients with -positive BC, the NAC strategy is more beneficial than the AC strategy, particularly in cN-positive and postmenopausal patients. NAC should be used as a first-line treatment for -positive tumors.
新辅助化疗（NAC）对早期乳腺癌（BC）患者的阳性肿瘤尚未显示出生存获益。本研究的目的是比较接受NAC治疗的阳性BC患者与接受辅助化疗（AC）治疗的患者的预后。
我们回顾性分析了202例接受NAC治疗的阳性患者和701例接受AC治疗的患者的无病生存期（DFS）和总生存期（OS）。所有患者除化疗外均接受曲妥珠单抗治疗。通过倾向评分对患者数据进行加权以克服选择偏倚。
在进行治疗权重的逆概率（IPTW）调整后，总体人群中各治疗组之间的DFS无差异（P = 0.3）。然而，多因素分析发现，cN状态与化疗策略之间存在交互作用（IPTW校正后的风险比cHR = 0.52，95%可信区间（0.3 - 0.9），P = 0.08），绝经状态与化疗（CT）策略之间也存在交互作用（cHR = 0.35，95%可信区间（0.18 - 0.7），P < 0.01）。在cN阳性患者和绝经后患者中，NAC策略比AC策略更有益。此外，经过IPTW调整后，多因素分析显示新辅助策略具有显著的OS获益（cHR = 0.09，95%可信区间[0.02 - 0.35]，P < 0.001）。
在阳性BC患者中, NAC策略比AC策略更有益，尤其是在cN阳性和绝经后患者中。NAC应用作阳性肿瘤的一线治疗。
