Lee Janghee, Kim Jee-Ye, Bae Soong-June, Cho Yeona, Ji Jung-Hwan, Kim Dooreh, Ahn Sung-Gwe, Park Hyung-Seok, Park Seho, Kim Seung-Il, Park Byeong-Woo, Jeong Joon
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
Department of Surgery, Sacred Heart Hospital, Hallym University, Dongtan 18450, Korea.
Cancers (Basel). 2021 Dec 9;13(24):6205. doi: 10.3390/cancers13246205.
This study aimed to determine whether post-mastectomy radiotherapy (PMRT) is beneficial for the prognosis of patients who achieved pathologic complete response (pCR), or who had minimal residual disease, after undergoing neoadjuvant chemotherapy (NAC). Patients who underwent a total mastectomy between 2006 and 2018, after NAC, were included. Patients who did not receive PMRT were matched using 1:3 propensity score matching (PSM). Kaplan-Meier survival curves were used to compare locoregional recurrence-free survival (LRRFS) and overall survival (OS). A total of 368 patients were included after 1:3 PSM. PMRT improved the LRRFS ( = 0.016) and OS ( = 0.017) rates of patients who underwent NAC. However, PMRT did not affect the prognosis of patients with pCR (LRRFS: = 0.999; OS: = 0.453). In addition, PMRT had a limited effect on LRRFS and OS in patients who responded well to NAC, with a neoadjuvant response index (NRI) value of 0.7-1.0 (LRRFS: = 0.568; OS: = 0.875). PMRT improved the OS of patients with a large residual tumor burden, such as nodal metastases or pathologic stage II/III. The benefits of PMRT vary depending on the patients' response to NAC, although PMRT is useful for treating patients who underwent NAC. PMRT can be omitted, not only in patients with pCR, but also in good responders with an NRI value of 0.7-1.0.
本研究旨在确定保乳术后放疗（PMRT）对于在接受新辅助化疗（NAC）后达到病理完全缓解（pCR）或残留疾病极少的患者的预后是否有益。纳入了2006年至2018年间在接受NAC后行全乳切除术的患者。未接受PMRT的患者采用1:3倾向评分匹配（PSM）进行匹配。使用Kaplan-Meier生存曲线比较局部区域无复发生存率（LRRFS）和总生存率（OS）。经过1:3 PSM后共纳入368例患者。PMRT提高了接受NAC患者的LRRFS（P = 0.016）和OS（P = 0.017）率。然而，PMRT对pCR患者的预后没有影响（LRRFS：P = 0.999；OS：P = 0.453）。此外，对于新辅助反应指数（NRI）值为0.7 - 1.0且对NAC反应良好的患者，PMRT对LRRFS和OS的影响有限（LRRFS：P = 0.568；OS：P = 0.875）。PMRT提高了有较大残留肿瘤负荷患者的OS，如出现淋巴结转移或病理分期为II/III期的患者。尽管PMRT对接受NAC的患者有用，但其益处因患者对NAC的反应而异。不仅pCR患者，而且NRI值为0.7 - 1.0的良好反应者都可以省略PMRT。
