在乳腺癌中，新辅助化疗期间达到病理完全缓解的患者比辅助化疗的结局更好：一项比较研究。

Patients achieved pCR during neoadjuvant chemotherapy had better outcome than adjuvant chemotherapy setting in breast cancer: A comparative study.

机构信息

Department of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China.

Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China.

出版信息

Cancer Treat Res Commun. 2023;36:100719. doi: 10.1016/j.ctarc.2023.100719. Epub 2023 May 10.

DOI:10.1016/j.ctarc.2023.100719

PMID:37187018

Abstract

PURPOSE

Pathological complete response(pCR) during neoadjuvant chemotherapy(NAC) has been proposed as a predictor for better prognosis in breast cancer. However, few studies compare the outcomes of patients receiving NAC and adjuvant chemotherapy(AC).

METHODS

We retrospectively matched the patients who received NAC(N = 462) and AC(N = 462) by age, time of diagnosis, and primary clinical stage using the propensity score match in breast cancer patients treated in Sir Run Run Shaw Hospital with the median follow up of 67 months. Death from breast cancer and recurrence were used as endpoints. A multivariable Cox models were used to estimate the hazard ratios for breast-cancer specific survival (BCSS) and DFS. A multivariable logistic regression model was simulated to predict pCR.

RESULTS

In patients who received NAC, 18.0%(83/462) patients achieved pCR, while the rest of the patients did not. pCR subgroup demonstrated significant better BCSS and DFS than patients receiving AC(BCSS: HR = 0.39, 95% CI:0.12-0.93, P = 0.03; DFS: HR = 0.16, 95%CI 0.009-0.73, P = 0.013) and non-pCR patients(BCSS: HR = 0.32, 95%CI 0.10-0.77, P = 0.008; DFS: HR = 0.12, 95%CI 0.007-0.55, P = 0.002). Patients who received AC demonstrated insignificant survival compared to non-pCR patients(BCSS: HR= 0.82, 95%CI 0.62-1.10, P = 0.19; DFS: HR = 0.75, 95%CI 0.53-1.07, P = 0.12). Patients with AC had significant better DFS than non-pCR patients(HR = 0.33, 95% CI 0.10-0.94, P = 0.04) in luminal B Her2+ patients. More NAC cycles(>2), TNBC, lower cT stage, and mixed histology indicate higher possibility of pCR(AUC = 0.89).

CONCLUSION

pCR patients with NAC indicated better prognosis than patients receiving AC or non-pCR patients from NAC. The timing of chemotherapy may need carefully pondering in luminal B Her2+ patients.

摘要

目的

新辅助化疗（NAC）期间的病理完全缓解（pCR）已被提议作为乳腺癌预后更好的预测指标。然而，很少有研究比较接受 NAC 和辅助化疗（AC）的患者的结局。

方法

我们通过年龄、诊断时间和主要临床分期，使用倾向性评分匹配，对在浙江大学医学院附属邵逸夫医院接受治疗的乳腺癌患者中接受 NAC（N=462）和 AC（N=462）的患者进行了回顾性匹配，中位随访时间为 67 个月。以乳腺癌死亡和复发为终点。使用多变量 Cox 模型估计乳腺癌特异性生存（BCSS）和无病生存（DFS）的风险比。模拟多变量逻辑回归模型预测 pCR。

结果

在接受 NAC 的患者中，18.0%（83/462）的患者达到 pCR，其余患者未达到 pCR。pCR 亚组的 BCSS 和 DFS 明显优于接受 AC（BCSS：HR=0.39，95%CI：0.12-0.93，P=0.03；DFS：HR=0.16，95%CI 0.009-0.73，P=0.013）和非 pCR 患者（BCSS：HR=0.32，95%CI 0.10-0.77，P=0.008；DFS：HR=0.12，95%CI 0.007-0.55，P=0.002）。接受 AC 的患者与非 pCR 患者相比，生存情况无显著差异（BCSS：HR=0.82，95%CI 0.62-1.10，P=0.19；DFS：HR=0.75，95%CI 0.53-1.07，P=0.12）。在 luminal B Her2+患者中，接受 AC 的患者与非 pCR 患者相比，DFS 显著更好（HR=0.33，95%CI 0.10-0.94，P=0.04）。接受更多的 NAC 周期（>2 个）、三阴性乳腺癌、较低的 cT 分期和混合组织学提示更高的 pCR 可能性（AUC=0.89）。