Ma Tianyi, Mao Yan, Wang Haibo
Department of Breast Center of the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, 266000, People's Republic of China.
Cancer Manag Res. 2021 Feb 3;13:989-998. doi: 10.2147/CMAR.S287089. eCollection 2021.
This study aimed to evaluate the impact of surgical time on postoperative complications and survival outcomes in breast cancer patients after neoadjuvant chemotherapy (NAC).
We retrospectively reviewed breast cancer patients treated at Breast Disease Center of the Affiliated Hospital of Qingdao University, from January 2013 to December 2018. The eligibility criteria were female patients with histologically confirmed primary stage II-III breast cancer and initially treated with NAC, who were <75 years old, and patients for whom medical records were available. The patients with severe comorbidities of other organs, with previous histories of other malignancies or breast cancer, and with distant metastasis or contralateral breast cancer, were excluded. Eligible patients were divided into three groups based on time to surgery (TTS): (A) ≤21 days; (B) between 21 and 28 days; and (C) >28 days. We collected medical records and followed up patients.
Totally 422 patients were enrolled. The median TTS was 26 days. Among these patients, 119 (28.2%) were in Group A, 152 (36.0%) were in Group B, and 151 (35.8%) were in Group C. Eighty-two (19.4%) patients achieved pathologic complete response (pCR). Survival analysis showed that DFS (P=0.012) and OS (P=0.015) were significantly different among three groups. In multivariate analysis, DFS (HR=2.333, P=0.001) and OS (HR=2.783, P=0.030) were significantly worse when TTS >28 days. Postoperative complications occurred in 96 (22.7%) patients. The incidence of total postoperative complications in the three groups was statistically different (P=0.001) and Group A had worse performance. Multivariate analysis showed that age >50 years old (P=0.004) and TTS ≤21 days (P<0.001) were independent parameters for total postoperative complications.
Postoperative complications and survival outcomes in breast cancer patients seemed to be influenced by TTS after the NAC. The benefits were remarkable in patients undergoing surgery between 21 and 28 days.
本研究旨在评估新辅助化疗（NAC）后手术时间对乳腺癌患者术后并发症及生存结局的影响。
我们回顾性分析了2013年1月至2018年12月在青岛大学附属医院乳腺疾病中心接受治疗的乳腺癌患者。纳入标准为组织学确诊为原发性II-III期乳腺癌且初始接受NAC治疗、年龄<75岁且有完整病历的女性患者。排除有其他器官严重合并症、既往有其他恶性肿瘤或乳腺癌病史、有远处转移或对侧乳腺癌的患者。符合条件的患者根据手术时间（TTS）分为三组：（A）≤21天；（B）21至28天之间；（C）>28天。我们收集了病历并对患者进行随访。
共纳入422例患者。TTS的中位数为26天。其中，A组119例（28.2%），B组152例（36.0%），C组151例（35.8%）。82例（19.4%）患者达到病理完全缓解（pCR）。生存分析显示，三组间无病生存期（DFS，P=0.012）和总生存期（OS，P=0.015）存在显著差异。多因素分析显示，当TTS>28天时，DFS（风险比[HR]=2.333，P=0.001）和OS（HR=2.783，P=0.030）显著更差。96例（22.7%）患者发生术后并发症。三组术后并发症总发生率有统计学差异（P=0.001），A组情况更差。多因素分析显示，年龄>50岁（P=0.004）和TTS≤21天（P<0.001）是术后并发症总发生率的独立影响因素。
NAC后乳腺癌患者的术后并发症及生存结局似乎受TTS影响。手术时间在21至28天之间的患者获益显著。
