Division of General Surgery, Western University, London, ON N6A 3K7, Canada.
Curr Oncol. 2024 Oct 8;31(10):6007-6016. doi: 10.3390/curroncol31100448.
The utility of neoadjuvant chemotherapy is expanding in the treatment of breast cancer. Although individual trials have shown comparable survival between patients receiving neoadjuvant and adjuvant chemotherapy, large-scale data analyses for outcomes in patients with locally advanced breast cancer (LABC) are lacking. We conducted an individual-level statistical analysis using patients from six randomized controlled trials (RCTs) investigating survival outcomes with neoadjuvant versus adjuvant chemotherapy in breast cancer by abstracting and analyzing only the patients with LABC. Individual patient data for 779 patients with LABC were collected from six RCTs. Overall and disease-free survival rates were compared between patients receiving neoadjuvant vs. adjuvant chemotherapy with the Cox hazard model and log-rank statistics. Since chemotoxicity causing delays to surgical care is a potential drawback of neoadjuvant chemotherapy, local cohort data were then employed to assess the actual incidence of this, along with the causes behind any delays to surgery in patients receiving neoadjuvant chemotherapy. A time interval from neoadjuvant chemotherapy to surgery of >8 weeks was investigated in a local cohort of 563 patients, representing all locally treated patients receiving neoadjuvant chemotherapy between 2006 and 2019. The statistical analysis demonstrated no overall or disease-free survival differences in LABC patients receiving neoadjuvant vs. adjuvant chemotherapy ( = 0.96 and 0.74, respectively). Within our cohort, 31 (5.5%) patients treated with neoadjuvant chemotherapy experienced a delay of >8 weeks to surgery, with only 13 (2.3%) attributed to chemotherapy-related complications. Our study provides further support for the paradigm shift towards delivering chemotherapy for breast cancer patients in the neoadjuvant setting.
新辅助化疗在乳腺癌治疗中的应用正在扩大。虽然个别试验表明接受新辅助化疗和辅助化疗的患者的生存情况相当，但缺乏局部晚期乳腺癌（LABC）患者结局的大规模数据分析。我们通过仅提取和分析 LABC 患者，对 6 项新辅助化疗与辅助化疗治疗乳腺癌的生存结局的随机对照试验（RCT）中的患者进行了个体水平的统计分析。从 6 项 RCT 中收集了 779 例 LABC 患者的个体患者数据。使用 Cox 风险模型和对数秩检验比较了接受新辅助化疗与辅助化疗患者的总生存和无病生存率。由于化疗毒性导致手术护理延迟是新辅助化疗的一个潜在缺点，因此随后使用局部队列数据评估了这种情况的实际发生率，以及接受新辅助化疗患者手术延迟的原因。在 563 例接受新辅助化疗的局部队列中，研究了从新辅助化疗到手术的时间间隔 >8 周的情况，这些患者代表了 2006 年至 2019 年间所有接受新辅助化疗的局部治疗患者。统计分析显示，接受新辅助化疗与辅助化疗的 LABC 患者的总生存和无病生存无差异（分别为 = 0.96 和 0.74）。在我们的队列中，31 例（5.5%）接受新辅助化疗的患者手术延迟 >8 周，其中只有 13 例（2.3%）归因于化疗相关并发症。我们的研究为在新辅助环境下为乳腺癌患者提供化疗的范式转变提供了进一步的支持。
