Division of Breast Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.
Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2023 Oct;30(11):6506-6515. doi: 10.1245/s10434-023-13730-x. Epub 2023 Jul 17.
Given the potential impact of increasingly effective neoadjuvant chemotherapy (NACT) on post-mastectomy radiotherapy (PMRT) recommendations, we examined temporal trends in post-NACT PMRT for cT3 breast cancer.
We identified women ≥ 18 years in the National Cancer Database (NCDB) diagnosed 2004-2019 with cT3N0-1M0 breast cancer treated with chemotherapy and mastectomy. Multivariable logistic regression and Cox proportional hazards models were used to estimate associations between pathologic NACT response [complete response (CR), partial response (PR), or no response (NR); or disease progression (DP)] and PMRT and between PMRT and overall survival (OS), respectively.
We identified 39,901 women (Asian/Pacific Islander 1731, Black 5875, Hispanic 3265, White 27,303). Among cN0 patients with CR, PMRT rates declined from 67% in 2004 to 35% in 2019 but remained unchanged for patients with DP. Relative to NR, CR [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.29-0.46] and PR (OR 0.44, 95% CI 0.36-0.55) in cN0 patients were associated with lower odds of PMRT while DP (OR 1.33, 95% CI 1.05-1.69) was associated with higher odds. Among cN1 patients, PMRT rates decreased from 90% to 73% for CR between 2005 and 2019 and increased from 76% to 82% for DP between 2004 and 2019. Relative to NR, CR (OR 0.78, 95% CI 0.63-0.95) was associated with lower odds of PMRT while DP (OR 1.93, 95% CI 1.58-2.37) was associated with higher odds. PMRT was associated with improved OS among cN1 patients (hazard ratio (HR) 0.77, 95% CI 0.67-0.88).
CR was associated with decreased PMRT receipt over time, while temporal trends following PR and DP differed by cN status, suggesting that nodal involvement guided PMRT receipt more than in-breast disease.
鉴于新辅助化疗（NACT）效果的提高可能对乳房切除术放疗（PMRT）的建议产生影响，我们研究了 cT3 乳腺癌接受 NACT 后 PMRT 的时间趋势。
我们在国家癌症数据库（NCDB）中确定了 2004 年至 2019 年期间≥18 岁的接受化疗和乳房切除术治疗的 cT3N0-1M0 乳腺癌女性。多变量逻辑回归和 Cox 比例风险模型用于估计病理 NACT 反应（完全缓解[CR]、部分缓解[PR]或无反应[NR]；或疾病进展[DP]）与 PMRT 之间以及 PMRT 与总生存（OS）之间的关联。
我们确定了 39901 名女性（亚洲/太平洋岛民 1731 名，黑人 5875 名，西班牙裔 3265 名，白人 27303 名）。在 cN0 患者中，CR 患者的 PMRT 率从 2004 年的 67%下降到 2019 年的 35%，但 DP 患者的 PMRT 率保持不变。与 NR 相比，cN0 患者中 CR（比值比[OR]0.36，95%置信区间[CI]0.29-0.46）和 PR（OR 0.44，95%CI 0.36-0.55）与 PMRT 的可能性较低相关，而 DP（OR 1.33，95%CI 1.05-1.69）与 PMRT 的可能性较高相关。在 cN1 患者中，CR 的 PMRT 率从 2005 年至 2019 年从 90%下降至 73%，而 DP 的 PMRT 率从 2004 年至 2019 年从 76%上升至 82%。与 NR 相比，CR（OR 0.78，95%CI 0.63-0.95）与 PMRT 的可能性较低相关，而 DP（OR 1.93，95%CI 1.58-2.37）与 PMRT 的可能性较高相关。PMRT 与 cN1 患者的 OS 改善相关（风险比[HR]0.77，95%CI 0.67-0.88）。
CR 与 PMRT 接受率随时间降低有关，而 PR 和 DP 后的时间趋势因 cN 状态而异，这表明淋巴结受累比乳腺癌内疾病更能指导 PMRT 的接受。
