Liu Xingrong, Eriksson Bergman Louise, Boman Caroline, Foukakis Theodoros, Matikas Alexios
Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden.
Karolinska Institutet, Oncology/Pathology Department, Stockholm, Sweden; Department of Surgery and Oncology, Capio Sankt Göran Hospital, Stockholm, Sweden.
Eur J Surg Oncol. 2025 Mar;51(3):109587. doi: 10.1016/j.ejso.2025.109587. Epub 2025 Jan 7.
Although neoadjuvant systemic treatment for non-metastatic breast cancer has gained ground during the past decade, there is no compelling evidence that it improves overall survival compared to primary tumor resection and adjuvant treatment. At the same time, the approach to responders to neoadjuvant treatment in the axilla is evolving.
This is a retrospective analysis of a prospectively collected population-based registry. Patients that received neoadjuvant (n = 2126) or adjuvant chemotherapy (n = 4754) for non-metastatic breast cancer during 2007-2020 in the Stockholm-Gotland region, which comprises 25 % of the entire Swedish population, were included. Overall survival of patients treated preoperatively and postoperatively was compared using inverse probability treatment weighting and landmark analysis. The prognostic impact of change between prechemotherapy clinical to postchemotherapy pathologic nodal stage (cN/pN) in women receiving neoadjuvant treatment was investigated.
Median follow-up was 4.93 years. There was no difference in adjusted overall survival between adjuvant (reference) and neoadjuvant treatment in the entire population (HR = 1.38, 95 % CI 0.98-1.93, p = 0.062) or in breast cancer subtypes. Patients converting from positive clinical to negative pathologic nodal stage (cN+/pN0) had improved outcomes compared to cN0/pN0 or patients with pN0 following primary surgery. These patients had a particular disease trajectory, with early peak in risk of death followed by quick and sustained decrease.
There was no difference in survival of patients treated with neoadjuvant versus adjuvant systemic therapy for non-metastatic breast cancer. Patients with cN+/pN0 have excellent prognosis and represent potential candidates for de-escalation of local and systemic treatment.
尽管在过去十年中，非转移性乳腺癌的新辅助全身治疗已得到广泛应用，但尚无确凿证据表明与原发性肿瘤切除及辅助治疗相比，它能提高总生存率。与此同时，腋窝新辅助治疗反应者的治疗方法也在不断演变。
这是一项对前瞻性收集的基于人群的登记数据进行的回顾性分析。纳入了2007年至2020年期间在斯德哥尔摩 - 哥特兰地区接受非转移性乳腺癌新辅助化疗（n = 2126）或辅助化疗（n = 4754）的患者，该地区人口占瑞典总人口的25%。采用逆概率治疗加权法和标志性分析比较术前和术后治疗患者的总生存率。研究了接受新辅助治疗的女性化疗前临床淋巴结分期与化疗后病理淋巴结分期（cN/pN）变化的预后影响。
中位随访时间为4.93年。在整个人群（HR = 1.38，95%CI 0.98 - 1.93，p = 0.062）或乳腺癌亚型中，辅助治疗（对照）和新辅助治疗之间的调整后总生存率无差异。从临床阳性转为病理阴性淋巴结分期（cN + /pN0）的患者与cN0/pN0患者或初次手术后pN0患者相比，预后有所改善。这些患者有特定的疾病轨迹，死亡风险早期达到峰值，随后迅速且持续下降。
非转移性乳腺癌新辅助治疗与辅助全身治疗患者的生存率无差异。cN + /pN0患者预后良好，是局部和全身治疗降阶梯的潜在候选者。
