Cao Lu, Xu Cheng, Wang Meng-Di, Qi Wei-Xiang, Cai Gang, Cai Rong, Wang Shu-Bei, Ou Dan, Li Min, Shen Kun-Wei, Chen Jia-Yi
Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Oncol. 2022 Jul 15;12:905223. doi: 10.3389/fonc.2022.905223. eCollection 2022.
To determine the relationship between time to radiotherapy (TTR) and survival outcomes in breast cancer (BC) patients treated with neoadjuvant treatments (NATs).
Continuous non-metastatic BC patients receiving NAT and adjuvant radiotherapy (RT) from 2009 to 2016 were retrospectively reviewed. A multivariable Cox model with restricted cubic splines (RCSs) was used to determine the panoramic relationship between TTR and survival outcomes. Multivariable analysis was used to control for confounding factors between the groups of TTR.
A total of 315 patients were included. The RCS modeling demonstrated a non-linear relationship between TTR and survival outcomes. The lowest risk for distant metastasis-free survival (DMFS) and recurrence-free survival (RFS) was observed at the TTR of 12 weeks, and the lowest risk of BC-specific survival (BCSS) at 10 weeks. TTR was accordingly transformed into categorical variables as ≤10, 11-20, and >20 weeks. Multivariable analysis revealed that the TTR of ≤10 weeks was an independent prognostic factor for worse DMFS (HR = 2.294, 95% CI 1.079-4.881) and RFS (HR = 2.126, 95% CI 1.038-4.356) compared with the TTR of 10-20 weeks, while the is no difference in DMFS, RFS, and BCSS between TTR >20 weeks and TTR of 10-20 weeks.
There exists a non-linear relationship between TTR after surgery and survival outcomes in patients treated with NAT. Early initiation of RT following surgery does not seem to be associated with a better therapeutic outcome. A relatively flexible recommendation of TTR could be adopted in clinical practice.
确定接受新辅助治疗（NATs）的乳腺癌（BC）患者的放疗时间（TTR）与生存结果之间的关系。
回顾性分析2009年至2016年接受NAT和辅助放疗（RT）的连续非转移性BC患者。使用带有受限立方样条（RCSs）的多变量Cox模型来确定TTR与生存结果之间的全景关系。多变量分析用于控制TTR组之间的混杂因素。
共纳入315例患者。RCS建模显示TTR与生存结果之间存在非线性关系。在TTR为12周时观察到远处无转移生存（DMFS）和无复发生存（RFS）的风险最低，在10周时观察到BC特异性生存（BCSS）的风险最低。因此，TTR被转换为分类变量，即≤10周、11 - 20周和>20周。多变量分析显示，与10 - 20周的TTR相比，≤10周的TTR是DMFS（HR = 2.294，95%CI 1.079 - 4.881）和RFS（HR = 2.126，95%CI 1.038 - 4.356）较差的独立预后因素，而TTR>20周与10 - 20周的TTR在DMFS、RFS和BCSS方面无差异。
接受NAT治疗的患者术后TTR与生存结果之间存在非线性关系。术后早期开始放疗似乎与更好的治疗结果无关。在临床实践中可以采用相对灵活的TTR推荐。
