Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2024 Nov;31(12):8057-8067. doi: 10.1245/s10434-024-16026-w. Epub 2024 Aug 19.
Patients with inflammatory breast cancer (IBC) have worse survival compared with stage III non-IBC matched cohorts; however, the prognostic significance of achieving pathologic complete response (pCR) in the setting of IBC is not well described. We evaluated overall survival (OS) between IBC patients and non-IBC patients who achieved pCR.
Adult females diagnosed in 2010-2018 with clinical prognostic stage III unilateral invasive breast cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery were selected from the National Cancer Database. Unadjusted OS from surgery was estimated using the Kaplan-Meier method, and log-rank tests were used to compare groups. Cox proportional hazard models were used to estimate the association of study groups with OS after adjustment for available covariates.
The study included 38,390 patients; n = 4600 (12.0%) IBC and n = 33,790 (88.0%) non-IBC. Overall pCR rates were lower for IBC compared with non-IBC (20.7% vs. 23.3%; p < 0.001). Among those achieving pCR, 5-year mortality was higher for IBC patients (16.4%, 95% confidence interval [CI] 13.9-19.1%) versus non-IBC patients (9.1%, 95% CI 8.4-9.8%; log-rank p < 0.001). Among all patients achieving pCR, IBC remained associated with worse OS compared with non-IBC (hazard ratio 1.48, 95% CI 1.19-1.85; p < 0.001).
We found a lower pCR rate and worse OS in IBC patients compared with non-IBC stage III patients. Despite effective systemic therapies, achieving a pCR for IBC patients may not carry the same prognostic impact compared with non-IBC stage III patients.
与 III 期非炎性乳腺癌（IBC）匹配队列相比，炎性乳腺癌（IBC）患者的生存情况更差；然而，在 IBC 背景下达到病理完全缓解（pCR）的预后意义尚不清楚。我们评估了在接受新辅助化疗（NAC）后接受手术治疗的 IBC 患者和达到 pCR 的非 IBC 患者之间的总生存期（OS）。
从国家癌症数据库中选择 2010 年至 2018 年间诊断为单侧浸润性乳腺癌的成年女性，这些患者临床预后分期为 III 期，接受 NAC 治疗后行手术治疗。使用 Kaplan-Meier 方法估计手术的未调整 OS，并使用对数秩检验比较组间差异。使用 Cox 比例风险模型估计研究组与 OS 的相关性，校正可用协变量。
研究纳入 38390 例患者；n=4600（12.0%）为 IBC，n=33790（88.0%）为非 IBC。IBC 的总体 pCR 率低于非 IBC（20.7%比 23.3%；p<0.001）。在达到 pCR 的患者中，IBC 患者的 5 年死亡率更高（16.4%，95%置信区间 [CI] 13.9-19.1%），而非 IBC 患者的死亡率更低（9.1%，95% CI 8.4-9.8%；对数秩检验 p<0.001）。在所有达到 pCR 的患者中，与非 IBC 相比，IBC 与更差的 OS 相关（风险比 1.48，95% CI 1.19-1.85；p<0.001）。
与 III 期非 IBC 患者相比，我们发现 IBC 患者的 pCR 率较低，OS 较差。尽管采用了有效的系统治疗，但 IBC 患者达到 pCR 可能并不具有与非 IBC 患者相同的预后意义。
