Wang Dandan, Sun Xiaowei, Sun Wen, Wang Ruoxi, Pan Hong, Zhou Wenbin
Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
Department of Breast Centre, Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
Breast. 2025 Jun;81:104454. doi: 10.1016/j.breast.2025.104454. Epub 2025 Mar 19.
Increasing evidence supports the use of neoadjuvant chemotherapy (NAC) prior to surgery for breast cancer. However, the optimal timing between NAC and surgery had yet to be fully elucidated. This meta-analysis aims to assess how the optimal interval time (OTT) between NAC and surgery affects outcomes in breast cancer, providing additional evidence for clinical practice and future research.
PubMed, Web of Science and Cochrane Library databases in English were systematically searched for this systematic review. All included studies investigated the variations in surgical timing following NAC and their effects on breast cancer outcomes. The endpoints included the rate of pathological complete response (pCR), overall survival (OS), recurrence free survival (RFS), and disease-free survival (DFS). This study has been registered with PROSPERQ.
Eleven eligible studies were identified, encompassing a total of 10,834 cases, all of which received surgery post-NAC. All studies were retrospective in nature. Ultimately, compared to intervals within 4 weeks, patients who underwent surgery>8weeks post-NAC demonstrated a statistically significant worse OS (HR = 1.21, 95 % CI: 1.06-1.40, p = 0.333 for heterogeneity). No significant difference of OS was observed between patients with OTT of 4-8 weeks vs < 4 weeks. Notably, patients with an OTT of 4-8 weeks (HR = 1.18, 95 % CI: 1.10-1.26, I = 0.0 %, p = 0.931 for heterogeneity) and>8weeks (HR = 1.21, 95 % CI: 1.13-1.29, I = 36.2 %, p = 0.195 for heterogeneity) exhibited decreasing RFS, compared with those with OTTs of<4 weeks. DFS and pCR rates were similar in>8weeks vs < 4 weeks and 4-8weeks vs < 4 weeks.
Our systematic review and meta-analysis indicate that the optimal interval following NAC for breast cancer patients might be within four weeks, as delays exceeding eight weeks could be associated with poorer clinical outcomes. However, additional research is necessary to validate these preliminary findings.
越来越多的证据支持在乳腺癌手术前使用新辅助化疗（NAC）。然而，NAC与手术之间的最佳时间尚未完全阐明。本荟萃分析旨在评估NAC与手术之间的最佳间隔时间（OTT）如何影响乳腺癌的治疗结果，为临床实践和未来研究提供更多证据。
系统检索了英文的PubMed、Web of Science和Cochrane图书馆数据库进行本系统评价。所有纳入研究均调查了NAC后手术时间的变化及其对乳腺癌治疗结果的影响。终点指标包括病理完全缓解（pCR）率、总生存期（OS）、无复发生存期（RFS）和无病生存期（DFS）。本研究已在PROSPERQ注册。
共纳入11项符合条件的研究，共计10834例病例，所有病例均在NAC后接受了手术。所有研究均为回顾性研究。最终，与4周内进行手术的患者相比，NAC后超过8周进行手术的患者的OS在统计学上显著更差（HR = 1.21，95%CI：1.06 - 1.40，异质性p = 0.333）。OTT为4 - 8周的患者与<4周的患者相比，OS无显著差异。值得注意的是，与OTT<4周的患者相比，OTT为4 - 8周（HR = 1.18，95%CI：1.10 - 1.26，I = 0.0%，异质性p = 0.931）和>8周（HR = 1.21，95%CI：1.13 - 1.29，I = 36.2%，异质性p = 0.195）的患者的RFS呈下降趋势。>8周与<4周以及4 - 8周与<4周的DFS和pCR率相似。
我们的系统评价和荟萃分析表明，乳腺癌患者NAC后的最佳间隔时间可能在4周内，因为超过8周的延迟可能与较差的临床结果相关。然而，需要更多研究来验证这些初步发现。
