Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden; Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.
Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden.
Eur J Surg Oncol. 2023 Jul;49(7):1189-1195. doi: 10.1016/j.ejso.2023.03.225. Epub 2023 Mar 28.
Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC.
This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014-2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS versus mastectomy), including tumor subtype, by gene expression analysis.
The overall BCS rate was 52%, and this rate increased during the study period (from 37% to 52%). Pathological complete response was achieved in 69 patients (30%). Predictors for BCS were smaller tumor size on mammography, visibility on ultrasound, histological subtype other than lobular, benign axillary status, and a diagnosis of triple-negative or HER2-positive subtype, with a similar trend for gene expression subtypes. Mammographic density was negatively related to BCS in a dose-response pattern. In the multivariable logistic regression model, tumor stage at diagnosis and mammographic density showed the strongest association with BCS.
The rate of BCS after NAC increased during the study period to 52%. With modern treatment options for NAC the potential for tumor response and BCS eligibility might further increase.
新辅助化疗（NAC）是早期乳腺癌的一种既定治疗选择，可使肿瘤降期，并增加保乳手术（BCS）的适应证。本研究的主要目的是评估 NAC 后 BCS 的比率，次要目的是确定 NAC 后应用 BCS 的预测因素。
这是一项在 2014 年至 2019 年间进行的 SCAN-B（临床试验 NCT02306096）新辅助队列的观察性前瞻性队列研究，共纳入 226 例患者。在基线和 NAC 后评估 BCS 的适应证。使用具有临床意义或与结局（BCS 与乳房切除术）相关的协变量（包括通过基因表达分析的肿瘤亚型）进行单变量和多变量逻辑回归分析。
总体 BCS 率为 52%，且该比率在研究期间增加（从 37%增至 52%）。69 例患者（30%）达到病理完全缓解。BCS 的预测因素包括乳腺 X 线摄影上肿瘤较小、超声可见、组织学亚型非小叶、腋窝良性状态以及诊断为三阴性或 HER2 阳性亚型，基因表达亚型也存在类似趋势。乳腺 X 线摄影密度与 BCS 呈负相关，呈剂量反应模式。在多变量逻辑回归模型中，诊断时的肿瘤分期和乳腺 X 线摄影密度与 BCS 相关性最强。
NAC 后 BCS 的比率在研究期间增加至 52%。随着 NAC 现代治疗选择的出现，肿瘤反应和 BCS 适应证的潜力可能进一步增加。
