Zhang Nana, Shan Ming, Huang Zhenfeng, Gao Fei, Xu Bingqi, Kang Wenli, Zhang Jian, Song Li, Liu Jun, Zhang Jiawei, Liu Mingyang, Jiang Haitao, Liu Xinhang, Shen Zibo, Zhang Peng, Nanding Abiyasi, Zhang Guoqiang
Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China.
Department of Anorectum, Heilongjiang General Hospital of Daqing Oil Field, Daqing, Heilongjiang, China.
Front Pharmacol. 2025 Mar 25;16:1574665. doi: 10.3389/fphar.2025.1574665. eCollection 2025.
Neoadjuvant therapy for breast cancer improves the prognosis of high-risk patients. However, whether pathological completed response (pCR) can be used as a surrogate endpoint for de-escalation therapy in patients who are relatively sensitive to treatment remains to be elucidated.
We retrospectively reviewed 143 breast cancer patients, with clinical stage (cStage) II-IIIA who received neoadjuvant chemotherapy and achieved pCR in a short time (within 16 weeks) from 2012 to 2022. The prognosis of patients was analysed using the Kaplan-Meier method, Cox proportional hazards regression models to identify independent clinicopathologic factors affecting prognosis.
The median follow-up period was 47 months, the overall 4-year disease-free survival (DFS) and overall survival (OS) were 95.3% and 96.9%, respectively, in 143 patients with pCR after neoadjuvant chemotherapy. The 4-year DFS between the postoperative adjuvant chemotherapy and no adjuvant chemotherapy groups was 76.4% and 95.2%, with a significant statistical difference between both groups ( < 0.05). For HER2-positive (HER2+) and Triple negative breast cancer (TNBC), the addition of targeted therapy or platinum-based drugs had no impact on prognosis. Univariate and multivariate analyses of prognosis showed that only postoperative adjuvant chemotherapy significantly affected prognosis.
Patients with operable cStage II-IIIA breast cancer who achieved pCR after a short period of neoadjuvant chemotherapy have a satisfactory prognosis and may be suitable for chemotherapy "de-escalation." This approach is also a dominant application of neoadjuvant "tailoring therapy."
乳腺癌新辅助治疗可改善高危患者的预后。然而，对于治疗相对敏感的患者，病理完全缓解（pCR）是否可作为降阶梯治疗的替代终点仍有待阐明。
我们回顾性分析了2012年至2022年间143例临床分期（cStage）为II-IIIA期且接受新辅助化疗并在短时间内（16周内）达到pCR的乳腺癌患者。采用Kaplan-Meier法、Cox比例风险回归模型分析患者预后，以确定影响预后的独立临床病理因素。
中位随访期为47个月，143例新辅助化疗后达到pCR的患者4年无病生存率（DFS）和总生存率（OS）分别为95.3%和96.9%。术后辅助化疗组与未进行辅助化疗组的4年DFS分别为76.4%和95.2%，两组间差异有统计学意义（<0.05）。对于人表皮生长因子受体2阳性（HER2+）和三阴性乳腺癌（TNBC），添加靶向治疗或铂类药物对预后无影响。预后的单因素和多因素分析显示，只有术后辅助化疗显著影响预后。
可手术的cStage II-IIIA期乳腺癌患者在短期新辅助化疗后达到pCR，预后良好，可能适合化疗“降阶梯”。这种方法也是新辅助“个体化治疗”的主要应用方式。
