Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Breast. 2023 Aug;70:92-99. doi: 10.1016/j.breast.2023.06.008. Epub 2023 Jun 27.
AIM: To investigate the survival outcomes, patterns and risks of recurrence in cN3c breast cancer patients after multimodality therapy, as well as the predictors of candidates for ipsilateral supraclavicular (SCV) area boosting. METHOD: Consecutive cN3c breast cancer patients from January 2009 to December 2020 were retrospectively reviewed. Based on nodal response to primary systemic therapy (PST), patients were categorized into three groups: clinical complete response (cCR) not achieved in SCV lymph nodal (SCLN, Group A), SCLN cCR but axillary node (ALN) did not achieve pathological complete response (pCR, Group B), cCR in SCLN and pCR in ALN (Group C). RESULTS: The median follow-up time was 32.7 months. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 64.6% and 43.7% respectively. Multivariate analysis showed cumulative SCV dose and ypT stage, ALN response and SCV response to PST were significantly associated with OS and RFS respectively. Compared with Group A or B, Group C showed significantly improved 3 y-RFS (53.8% vs 73.6% vs 100%, p = 0.003), and the lowest rate of DM as first failure (37.9% vs 23.5% vs 0%, p = 0.010). In Group A, the 3 y-OS for patients receiving the cumulative SCV dose of ≥60 Gy versus <60 Gy was 78.0% versus 57.3% (p = 0.029). CONCLUSION: Nodal response to PST is an independent prognostic factor for survival and pattern of failure. A cumulative SCV dose of ≥60 Gy is positively associated with improved OS, especially in Group A. Our data supports the perspective of optimizing radiotherapeutic strategy based on nodal response.
目的：研究多模式治疗后 cN3c 乳腺癌患者的生存结果、复发模式和复发风险，以及同侧锁骨上（SCV）区域加量的候选者的预测因素。 方法：回顾性分析 2009 年 1 月至 2020 年 12 月连续的 cN3c 乳腺癌患者。根据原发系统性治疗（PST）后淋巴结的反应，患者分为三组：SCV 淋巴结（SCLN）未达到临床完全缓解（cCR，组 A）、SCLN 达到 cCR 但腋窝淋巴结（ALN）未达到病理完全缓解（pCR，组 B）、SCLN 和 pCR 在 ALN 中达到 cCR（组 C）。 结果：中位随访时间为 32.7 个月。5 年总生存率（OS）和无复发生存率（RFS）分别为 64.6%和 43.7%。多因素分析显示，累积 SCV 剂量和 ypT 分期、ALN 反应和 PST 后 SCV 反应与 OS 和 RFS 显著相关。与组 A 或 B 相比，组 C 显示出明显改善的 3 年 RFS（53.8%比 73.6%比 100%，p=0.003），以及作为首次失败的 DM 发生率最低（37.9%比 23.5%比 0%，p=0.010）。在组 A 中，接受累积 SCV 剂量≥60Gy 与<60Gy 的患者 3 年 OS 分别为 78.0%和 57.3%（p=0.029）。 结论：PST 后淋巴结的反应是生存和失败模式的独立预后因素。累积 SCV 剂量≥60Gy 与 OS 改善呈正相关，特别是在组 A 中。我们的数据支持基于淋巴结反应优化放射治疗策略的观点。
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