新辅助治疗后手术治疗的乳腺癌患者局部区域复发的影响因素。
Factors affecting locoregional recurrence in breast cancer patients undergoing surgery following neoadjuvant treatment.
机构信息
Department of General Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan.
出版信息
BMC Surg. 2021 Mar 23;21(1):160. doi: 10.1186/s12893-021-01158-7.
BACKGROUND
Neoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer for the purpose of downstaging or for conversion from mastectomy to breast conservation surgery (BCS). Locoregional recurrence (LRR) rate is still high after NAC. The aim of this study was to determine predictive factors for LRR in breast cancer patients in association with the operation types after NAC.
METHODS
Between 2005 and 2017, 1047 breast cancer patients underwent BCS or mastectomy after NAC in Chang Gung Memorial Hospital, Linkou. We obtained data regarding patient and tumor characteristics, chemotherapy regimens, clinical tumor response, tumor subtypes and pathological complete response (pCR), type of surgery, and recurrence.
RESULTS
The median follow-up time was 59.2 months (range 3.13-186.75 months). The mean initial tumor size was 4.89 cm (SD ± 2.95 cm). Of the 1047 NAC patients, 232 (22.2%) achieved pCR. The BCS and mastectomy rates were 41.3% and 58.7%, respectively. One hundred four patients developed LRR (9.9%). Comparing between patients who underwent BCS and those who underwent mastectomy revealed no significant difference in the overall LRR rate of the two groups, 8.8% in BCS group vs 10.7% in mastectomy group (p = 0.303). Multivariate analysis indicated that independent factors for the prediction of LRR included clinical N2 status, negative estrogen receptor (ER), and failure to achieve pCR. In subgroups of multivariate analysis, only negative ER was the independent factor to predict LRR in mastectomy group (p = 0.025) and hormone receptor negative/human epidermal growth factor receptor 2 positive (HR-/HER2 +) subtype (p = 0.006) was an independent factor to predict LRR in BCS patients. Further investigation according to the molecular subtype showed that following BCS, non-pCR group had significantly increased LRR compared with the pCR group, in HR-/HER2 + subtype (25.0% vs 8.3%, p = 0.037), and HR-/HER2- subtype (20.4% vs 0%, p = 0.002).
CONCLUSION
Clinical N2 status, negative ER, and failure to achieve pCR after NAC were independently related to the risk of developing LRR. Operation type did not impact on the LRR. In addition, the LRR rate was higher in non-pCR hormone receptor-negative patients undergoing BCS comparing with pCR patients.
背景
新辅助化疗（NAC）已成为局部晚期乳腺癌的标准治疗方法，目的是降期或将乳房切除术转换为保乳手术（BCS）。NAC 后局部区域复发（LRR）率仍然很高。本研究旨在确定与 NAC 后手术类型相关的乳腺癌患者 LRR 的预测因素。
方法
2005 年至 2017 年间，1047 例在长庚纪念医院林口接受 NAC 后行 BCS 或乳房切除术的乳腺癌患者。我们获得了有关患者和肿瘤特征、化疗方案、临床肿瘤反应、肿瘤亚型和病理完全缓解（pCR）、手术类型和复发的资料。
结果
中位随访时间为 59.2 个月（范围 3.13-186.75 个月）。初始肿瘤大小的平均值为 4.89 厘米（标准差±2.95 厘米）。在 1047 例接受 NAC 的患者中，232 例（22.2%）达到 pCR。BCS 和乳房切除术的比例分别为 41.3%和 58.7%。104 例患者发生 LRR（9.9%）。比较接受 BCS 和接受乳房切除术的患者，两组的总 LRR 率无显著差异，BCS 组为 8.8%，乳房切除术组为 10.7%（p=0.303）。多变量分析表明，预测 LRR 的独立因素包括临床 N2 状态、雌激素受体阴性（ER）和未能达到 pCR。在多变量分析的亚组中，仅 ER 阴性是预测乳房切除术组 LRR 的独立因素（p=0.025），激素受体阴性/人表皮生长因子受体 2 阳性（HR-/HER2+）亚型（p=0.006）是预测 BCS 患者 LRR 的独立因素。根据分子亚型进一步调查显示，在 HR-/HER2+亚型中，非 pCR 组与 pCR 组相比，LRR 显著增加（25.0%比 8.3%，p=0.037），HR-/HER2-亚型（20.4%比 0%，p=0.002）。
结论
NAC 后临床 N2 状态、ER 阴性和未能达到 pCR 与 LRR 风险独立相关。手术类型对 LRR 无影响。此外，与 pCR 患者相比，接受 BCS 的非 pCR 激素受体阴性患者的 LRR 率更高。
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