Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2024 Dec;31(13):8856-8865. doi: 10.1245/s10434-024-16178-9. Epub 2024 Sep 12.
Most patients with breast cancer treated with neoadjuvant chemotherapy (NAC) experience clinical benefit, however, a small proportion progress. We aimed to characterize factors predicting in-breast tumor progression and impact on distant recurrence.
We reviewed all patients with clinical stage I-III breast cancer treated with NAC in 2006-2021 at our institution. We compared in-breast progressive disease (PD), defined as ≥ 20% increase in tumor size, with stable disease (SD) or response. Distant recurrence-free survival (DRFS) was analyzed using the Kaplan-Meier method and Cox proportional hazards regression.
Of 1403 patients, 70 (5%) experienced in-breast PD, 243 (17%) SD, 560 (40%) partial response (PR), and 530 (38%) breast pathologic complete response (breast pCR, ypT0/Tis). The rate of PD varied by tumor subtype (8% in HR+/HER2-, 5% TNBC, 2% HER2+, p < 0.001). With median 48 months follow-up, the rates of DRFS were significantly different according to clinical breast response as follows: PD 56%, SD 68%, PR 82%, or breast pCR 93%, p < 0.001. In patients with PD on multivariable analysis, post-NAC grade (adjusted HR 2.9, p = 0.002) and ypT3-4 category (adjusted HR 2.4, p = 0.03) were the strongest predictors of DRFS. Combining these factors, 23% had neither, 44% had one, and 33% had both, which stratified outcome in PD with 3-year DRFS of 100%, 77%, and 30%, respectively (p < 0.001).
While in-breast PD during NAC is uncommon (5%), it predicts poor survival. Among patients with in-breast PD, post-NAC tumor grade and T category predict outcomes and may be useful to guide treatment escalation.
大多数接受新辅助化疗（NAC）治疗的乳腺癌患者都有临床获益，然而仍有一小部分患者出现进展。我们旨在描述预测乳腺内肿瘤进展的因素及其对远处复发的影响。
我们回顾了 2006 年至 2021 年在我们机构接受 NAC 治疗的所有 I-III 期乳腺癌患者。我们将乳腺内进行性疾病（PD），定义为肿瘤大小增加≥20%，与稳定疾病（SD）或反应进行比较。使用 Kaplan-Meier 方法和 Cox 比例风险回归分析远处无复发生存率（DRFS）。
在 1403 例患者中，70 例（5%）发生乳腺内 PD，243 例（17%）SD，560 例（40%）部分缓解（PR），530 例（38%）乳腺病理完全缓解（ypT0/Tis）。PD 发生率因肿瘤亚型而异（HR+/HER2-为 8%，TNBC 为 5%，HER2+为 2%，p<0.001）。中位随访 48 个月后，根据临床乳腺反应，DRFS 率明显不同，如下所示：PD 为 56%，SD 为 68%，PR 为 82%，或乳腺 pCR 为 93%，p<0.001。在多变量分析中，对于发生 PD 的患者，NAC 后分级（调整后的 HR 2.9，p=0.002）和 ypT3-4 类别（调整后的 HR 2.4，p=0.03）是 DRFS 的最强预测因素。将这些因素结合起来，23%的患者没有这些因素，44%的患者有一个因素，33%的患者有两个因素，这将 PD 患者的 3 年 DRFS 分层为 100%、77%和 30%，分别（p<0.001）。
尽管 NAC 期间乳腺内 PD 并不常见（5%），但它预示着不良的生存结果。在发生乳腺内 PD 的患者中，NAC 后肿瘤分级和 T 分类预测结局，可能有助于指导治疗升级。
