Yao Litong, Pang Zhiyuan, Wang Mozhi, Wang Mengshen, Sun Xiangyu, Cui Mingke, Zheng Yanfu, Li Xinyan, Dong Haoran, Zhang Qiang, Xu Yingying
Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang 110042, China.
Cancer Biol Med. 2021 Oct 12;19(5):755-67. doi: 10.20892/j.issn.2095-3941.2020.0800.
Neoadjuvant chemotherapy (NAC) is currently used in both early stage and locally advanced breast cancers. The survival benefits of standard non-standard NAC cycles are still unclear. This study aimed to investigate the relationship between NAC cycles and survival based on real world data.
We identified patients diagnosed with invasive primary breast cancers who underwent NAC followed by surgery. Patients who received at least 4 NAC cycles were defined as having received standard cycles, while patients who received less than 4 NAC cycles were defined as having received non-standard cycles. Kaplan-Meier curves and Cox proportional hazard models were used to estimate the disease-free survival (DFS) and overall survival (OS).
Of the 1,024 included patients, 700 patients received standard NAC cycles and 324 patients received non-standard NAC cycles. The DFS estimates were 87.1% and 81.0% ( = 0.007) and the OS estimates were 90.0% and 82.6% ( = 0.001) in the standard and non-standard groups, respectively. Using multivariate analyses, patients treated with standard NAC cycles showed significant survival benefits in both DFS [hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.44-0.88] and OS (HR: 0.54, 95% CI: 0.37-0.79). Using stratified analyses, standard NAC cycles were associated with improved DFS (HR: 0.59, 95% CI: 0.36-0.96) and OS (HR: 0.49, 95% CI: 0.28-0.86) in the HER2 positive group. Similar DFS (HR: 0.50, 95% CI: 0.25-0.98) and OS (HR: 0.45, 95% CI: 0.22-0.91) benefits were shown for the triple negative group.
Standard NAC cycles were associated with a significant survival benefit, especially in patients with HER2 positive or triple negative breast cancer.
新辅助化疗（NAC）目前用于早期和局部晚期乳腺癌。标准与非标准NAC疗程的生存获益仍不明确。本研究旨在基于真实世界数据探究NAC疗程与生存之间的关系。
我们纳入了诊断为原发性浸润性乳腺癌且接受NAC后手术的患者。接受至少4个NAC疗程的患者被定义为接受了标准疗程，而接受少于4个NAC疗程的患者被定义为接受了非标准疗程。采用Kaplan-Meier曲线和Cox比例风险模型来估计无病生存期（DFS）和总生存期（OS）。
在纳入的1024例患者中，700例患者接受了标准NAC疗程，324例患者接受了非标准NAC疗程。标准组和非标准组的DFS估计值分别为87.1%和81.0%（P = 0.007），OS估计值分别为90.0%和82.6%（P = 0.001）。通过多因素分析，接受标准NAC疗程治疗的患者在DFS[风险比（HR）：0.62，95%置信区间（CI）：0.44 - 0.88]和OS（HR：0.54，95% CI：0.37 - 0.79）方面均显示出显著的生存获益。通过分层分析，标准NAC疗程与HER2阳性组DFS的改善（HR：0.59，95% CI：0.36 - 0.96）和OS的改善（HR：0.49，95% CI：0.28 - 0.86）相关。三阴性组也显示出类似的DFS（HR：0.50，95% CI：0.25 - 0.98）和OS（HR：0.45，95% CI：0.22 - 0.91）获益。
标准NAC疗程与显著的生存获益相关，尤其是在HER2阳性或三阴性乳腺癌患者中。
