Holt Anouchka Coste, Smith Courtney A, Berkowitz Maurice J, Baker Jennifer L, McAndrew Nicholas P, Kapoor Nimmi S
Holy Cross and University of Miami, Fort Lauderdale, FL, USA.
Division of Surgical Oncology, Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.
Discov Oncol. 2024 Sep 20;15(1):467. doi: 10.1007/s12672-024-01349-7.
Adding pembrolizumab to neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) improves pathologic complete response (pCR) rates and event-free survival. The impact of adding immunotherapy to NAC on surgical outcomes is unknown. This study compares 90-day post-surgical complications (PSCs) and time to adjuvant treatment among patients undergoing NAC for TNBC with and without immunotherapy.
Patients treated with NAC alone or with immunotherapy (NAC-I) for stage I-III TNBC between 2018 and 2022 were retrospectively identified at a single academic institution. Kruskal-Wallis rank sum and Fisher's exact tests compared patient sociodemographic and clinical characteristics. Multivariable logistic regression determined odds ratios (OR) predicting PSCs.
Of 54 patients, 29 received NAC alone and 25 received NAC-I. Compared to NAC patients, NAC-I patients had more advanced stage tumors (p = 0.038), and had slightly higher rates of mastectomy with reconstruction (p = 0.193). 72.0% of NAC-I patients experienced a pCR, compared with 44.8% of NAC patients (p = 0.193). There were 10 PSCs (34.5%) in NAC patients compared to 9 PSCs (36.0%) in NAC-I patients (p > 0.99). Regression analysis demonstrated no association of PSCs with NAC-I (OR 0.83, 95% CI 0.19-3.60). Time to adjuvant therapy was shorter for NAC-I patients (28 days vs 36 days, p = 0.013).
Patients with TNBC receiving NAC-I have higher pCR rates and do not appear to have added 90-day PSCs or delays to adjuvant therapy despite trending toward more extensive surgical procedures compared to NAC alone. Larger studies are needed to further evaluate the surgical safety of immunotherapy.
在三阴性乳腺癌（TNBC）的新辅助化疗（NAC）中加入帕博利珠单抗可提高病理完全缓解（pCR）率和无事件生存率。在NAC中加入免疫疗法对手术结果的影响尚不清楚。本研究比较了接受NAC治疗的TNBC患者在接受和不接受免疫疗法的情况下术后90天并发症（PSC）和辅助治疗时间。
回顾性确定2018年至2022年间在单一学术机构接受I-III期TNBC单独NAC或联合免疫疗法（NAC-I）治疗的患者。采用Kruskal-Wallis秩和检验和Fisher精确检验比较患者的社会人口统计学和临床特征。多变量逻辑回归确定预测PSC的比值比（OR）。
54例患者中，29例仅接受NAC，25例接受NAC-I。与NAC患者相比，NAC-I患者的肿瘤分期更晚（p = 0.038），乳房切除并重建的比例略高（p = 0.193）。72.0%的NAC-I患者实现了pCR，而NAC患者为44.8%（p = 0.193）。NAC患者中有10例PSC（34.5%），而NAC-I患者中有9例PSC（36.0%）（p > 0.99）。回归分析表明PSC与NAC-I无关联（OR 0.83，95% CI 0.19 - 3.60）。NAC-I患者的辅助治疗时间更短（28天对36天，p = 0.013）。
接受NAC-I的TNBC患者pCR率更高，尽管与单独NAC相比，手术范围有扩大趋势，但似乎并未增加90天PSC或延迟辅助治疗。需要更大规模的研究来进一步评估免疫疗法的手术安全性。
