Yılmaz Cengiz, Zengel Baha, Üreyen Orhan, Adıbelli Zehra Hilal, Taşlı Funda, Yılmaz Hasan Taylan, Özdemir Özlem, Kocatepe Çavdar Demet, Mollamehmetoğlu Hülya, Çakıroğlu Umut, İmren Yaşar, Yakan Savaş, İlhan Enver
Bozyaka Education and Research Hospital, University of Health Sciences Turkey, 35170 Izmir, Turkey.
Department of Medical Oncology, Izmir City Hospital, 35540 Izmir, Turkey.
Cancers (Basel). 2025 Jan 7;17(2):163. doi: 10.3390/cancers17020163.
To evaluate the neoadjuvant chemotherapy (NACTx) process in breast cancer (BC), its significant treatment-related adverse events (trAEs), tumor clinical response rates, and surgical and pathological outcomes, and to analyze factors influencing cavity shaving and axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB). A comprehensive retrospective study was conducted at a single center on patients who received NACTx for BC between 2015 and 2021. Medical records of 242 patients were reviewed. Approximately one-fifth encountered grade ≥ 3 trAEs (21.5%), leading 3.3% to discontinue chemotherapy. Anthracycline cardiotoxicity (2.2%) caused one death (mortality rate = 0.4%). For clinical response and surgical and pathological outcomes, 229 patients were eligible. Clinical progression occurred in 3.9% of the patients (14% in triple-negative BC, = 0.004). Breast-conserving surgery (BCS) was performed in 55% of the patients. There was no significant difference between the type of breast surgery (BCS vs. mastectomy) and molecular subtype, histology, tumor size, or tumor's pathological response degree. Cavity shaving was required in one-fifth of the patients who underwent BCS (n = 134) due to an invasive tumor at the surgical margin (SM). Tumor histology (invasive ductal vs. invasive lobular carcinoma; OR: 4.962, 95% CI 1.007-24.441, = 0.049) and tumor SUVMax value (OR: 0.866, 95% CI 0.755-0.993, = 0.039) had significant independent efficacy on SM positivity. Initially, 75% underwent SLNB, but nearly half of them needed ALND. ALND rates were significantly higher in the luminal A and LB-HER2(-) groups (87% vs. 69%) than in the HER2(+) and TN groups (43% to 50%) ( = 0.001). All luminal A patients and those with lobular histology required ALND after SLNB, but no patients in the HER2-enriched group required ALND. ER positivity and higher PR expression levels were associated with an increased need for ALND after SLNB, whereas HER2 positivity and higher SUVMax values of LN(s) were associated with a significantly reduced need for ALND. About 27% of the patients achieved overall pCR. No pCR was achieved in the LA group. The BC NACTx process requires close monitoring due to severe AEs and disease progression. NACTx decisions must be made on experienced multidisciplinary tumor boards, considering tumor characteristics and expected targets.
评估乳腺癌（BC）新辅助化疗（NACTx）过程、其显著的治疗相关不良事件（trAEs）、肿瘤临床缓解率以及手术和病理结果，并分析前哨淋巴结活检（SLNB）后影响切缘修整和腋窝淋巴结清扫（ALND）的因素。在单一中心对2015年至2021年间接受BC NACTx的患者进行了一项全面的回顾性研究。回顾了242例患者的病历。约五分之一的患者发生≥3级trAEs（21.5%），导致3.3%的患者停止化疗。蒽环类药物心脏毒性（2.2%）导致1例死亡（死亡率=0.4%）。对于临床缓解以及手术和病理结果，229例患者符合条件。3.9%的患者发生临床进展（三阴性乳腺癌患者中为14%，P=0.004）。55%的患者接受了保乳手术（BCS）。乳房手术类型（BCS与乳房切除术）与分子亚型、组织学、肿瘤大小或肿瘤的病理反应程度之间无显著差异。在接受BCS的患者中（n=134），五分之一的患者因手术切缘（SM）存在浸润性肿瘤而需要进行切缘修整。肿瘤组织学（浸润性导管癌与浸润性小叶癌；OR：4.962，95%CI 1.007 - 24.441，P=0.049）和肿瘤SUVMax值（OR：0.866，95%CI 0.755 - 0.993，P=0.039）对SM阳性具有显著的独立影响。最初，75%的患者接受了SLNB，但其中近一半需要进行ALND。管腔A型和LB-HER2（-）组的ALND率（87%对69%）显著高于HER2（+）组和三阴组（43%至50%）（P=0.001）。所有管腔A型患者和小叶组织学患者在SLNB后需要进行ALND，但HER2富集组中无患者需要进行ALND。雌激素受体（ER）阳性和更高的孕激素受体（PR）表达水平与SLNB后对ALND的需求增加相关，而HER2阳性和淋巴结（LN）更高的SUVMax值与对ALND的需求显著降低相关。约27%的患者实现了总体病理完全缓解（pCR）。管腔A型组未实现pCR。由于严重不良事件和疾病进展，BC NACTx过程需要密切监测。NACTx决策必须在经验丰富的多学科肿瘤委员会上做出，同时考虑肿瘤特征和预期目标。
