分析新辅助化疗后内乳淋巴结转移患者病理完全缓解（ypCR）的影响因素。

Analysis of factors influencing the pathological complete remission (ipCR) in patients with internal mammary lymph node metastasis after neoadjuvant chemotherapy.

机构信息

Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.

出版信息

PeerJ. 2023 Oct 6;11:e16141. doi: 10.7717/peerj.16141. eCollection 2023.

DOI:10.7717/peerj.16141

PMID:37818328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10561637/

Abstract

OBJECTIVE

To investigate the factors impacting pathological complete remission (ipCR) of the internal mammary lymph nodes in patients with internal mammary lymph node metastasis (IMLN) after adjuvant chemotherapy.

METHODS

Sixty-five cases of primary breast cancer (BC) with IMLN metastasis who had received neoadjuvant chemotherapy (NAC) were retrospectively analyzed. Postoperative pathology was used to divide the patients into ipCR and non-ipCR groups. Univariate and multivariate analyses were performed on ipCR after NAC. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the factors related to ipCR and a Kaplan-Meier curve was used to analyze prognosis.

RESULTS

Twenty-nine (44.62%) of the 65 female patients received ipCR after NAC. Significant differences in hormone receptor (HR) negative and axillary pathological complete response (apCR) rates between the ipCR and non-ipCR group ( < 0.05). Multivariate logistic regression analysis showed that HR (OR = 2.698) and apCR (OR = 4.546) were the most significant factors that influenced ipCR ( < 0.05). The ROC curves showed that the area under the curves (AUC) for HR and apCR for the prediction of ipCR were 0.744 and 0.735 respectively. The AUC for the combined detection was 0.905. The average disease free survival (DFS) for patients in the ipCR group was 94.0 months which was significantly longer compared to patients in the non-ipCR group (64.2 months) (2 = 4.265, = 0.039). No significant difference in OS was detected between the two groups ( > 0.05).

CONCLUSIONS

ipCR after NAC is correlated with HR and apCR. HR combined with apCR has value in predicting ipCR. ipCR has prognostic value in patients with IMLN metastasis and may have the potential to inform clinical decision-making. Further validation of these findings is required through larger-scale prospective studies.

摘要

目的

探讨辅助化疗后内乳淋巴结转移（IMLN）患者内乳淋巴结病理完全缓解（ipCR）的影响因素。

方法

回顾性分析 65 例接受新辅助化疗（NAC）的原发性乳腺癌（BC）伴 IMLN 转移患者的临床资料。术后病理将患者分为 ipCR 组和非 ipCR 组。对 NAC 后 ipCR 的影响因素进行单因素和多因素分析。采用受试者工作特征（ROC）曲线评估与 ipCR 相关的因素的预测价值，采用 Kaplan-Meier 曲线分析预后。

结果

65 例女性患者中，29 例（44.62%）经 NAC 后获得 ipCR。ipCR 组和非 ipCR 组患者的激素受体（HR）阴性和腋窝病理完全缓解（apCR）率差异有统计学意义（P<0.05）。多因素 logistic 回归分析显示，HR（OR=2.698）和 apCR（OR=4.546）是影响 ipCR 的最显著因素（P<0.05）。ROC 曲线显示，HR 和 apCR 预测 ipCR 的曲线下面积（AUC）分别为 0.744 和 0.735。联合检测的 AUC 为 0.905。ipCR 组患者的平均无病生存（DFS）为 94.0 个月，明显长于非 ipCR 组（64.2 个月）（2=4.265，P=0.039）。两组患者的总生存（OS）差异无统计学意义（P>0.05）。