Falo Catalina, Azcarate Juan, Fernandez-Gonzalez Sergi, Perez Xavier, Petit Ana, Perez Héctor, Vethencourt Andrea, Vazquez Silvia, Laplana Maria, Ales Miriam, Stradella Agostina, Fullana Bartomeu, Pla Maria J, Gumà Anna, Ortega Raul, Varela Mar, Pérez Diana, Ponton Jose Luis, Cobo Sara, Benitez Ana, Campos Miriam, Fernández Adela, Villanueva Rafael, Obadia Veronica, Recalde Sabela, Soler-Monsó Teresa, Lopez-Ojeda Ana, Martinez Evelyn, Ponce Jordi, Pernas Sonia, Gil-Gil Miguel, Garcia-Tejedor Amparo
Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d'Oncologia, 08908 Barcelona, Spain.
Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain.
Cancers (Basel). 2024 Jun 30;16(13):2421. doi: 10.3390/cancers16132421.
: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. : A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. : The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, = 0.054. : Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.
乳腺癌新辅助化疗为简化乳房及腋窝手术提供了可能；它是一种体内化疗敏感性测试，具有重要的预后价值，可用于根据反应调整辅助治疗方案。对482例接受基于蒽环类和紫杉类药物的新辅助化疗（HER2阳性病例加用抗HER2药物）的II期和III期乳腺癌患者进行了单机构回顾性队列研究。计算5年和10年生存率。根据年龄、BRCA状态、绝经状态、TNM、病理和分子替代亚型、20%肿瘤浸润淋巴细胞（TIL）临界值、手术方式、化疗反应及血管侵犯情况，采用Kaplan-Meier曲线和对数秩检验计算差异。pCR率为25.3%，在HER2（51.3%）、三阴性乳腺癌（TNBC，31.7%）及BRCA携带者（41.9%）中更高。与患者生存独立相关的因素为病理和分子替代亚型、手术类型、新辅助化疗（NACT）反应及血管侵犯。BRCA状态是一个具有保护作用的预后因素，但未达到统计学意义，风险比（HR）为0.5（95%置信区间0.1 - 1.4）。与保乳手术（BCS）相比，乳房切除术出现远处复发的风险加倍，这支持了BCS作为NACT后一种安全选择。平均随访126（标准差43）个月后，腔面型肿瘤在5年或10年计算的生存率上存在显著差异（分别为81.2%和74.7%），而TNBC的5年和10年生存率分别为75.3%和73.5%。根据pCR反应差异最为明显，pCR患者10年无远处疾病生存率（DDFS）为95.5%，而非pCR患者为72.4%，P < 0.001。这种差异在TNBC中尤为显著：根据残余癌负荷（RCB）为0至3，10年DDFS分别为100%、80.6%、69%和49.2%，P < 0.001。预后特别差的患者为小叶癌患者，10年DDFS为42.9%，而导管癌为79.7%，P = 0.001；手术标本有血管侵犯的患者，10年DDFS为59.2%，无血管侵犯患者为83.6%，P < 0.001。值得注意的是，BRCA携带者生存期更长预计10年DDFS为89.6%，非携带者为77.2%，P = 0.054。新辅助化疗后的长期结果可帮助患者和临床医生做出明智决策。
