新辅助全身治疗对早期乳腺癌患者手术和放疗结果的影响：一项横断面回顾性单中心研究
Impact of neoadjuvant systemic therapy on surgical and radiotherapy outcomes in patients with early-stage breast cancer: a cross-sectional retrospective single-center study.
作者信息
Civil Yasmin A, Duvivier Katya M, Bartels Sanne A L, Velde Susanne van der, Oordt C Willemien Menke-van der Houven van, Barbé Ellis, Meij Suzan van der, Slotman Berend J, Bongard Desirée van den
机构信息
Department of Radiation Oncology, Amsterdam UMC, Amsterdam, The Netherlands.
Cancer Treatment and Quality of Life / Cancer Biology and Immunology, Cancer Center Amsterdam, Amsterdam, The Netherlands.
出版信息
BMC Cancer. 2025 Jul 1;25(1):1046. doi: 10.1186/s12885-025-14438-9.
INTRODUCTION
Neoadjuvant systemic therapy (NST) may cause non-concentric tumor shrinkage, complicating excision volume definition and potentially increasing radiotherapy boost volumes, affecting cosmetic outcomes. This study aims to compare excision and boost volumes in patients undergoing breast-conserving surgery (BCS) after NST versus no-NST, and assesses associations with quality of life (QoL) and cosmetic outcomes.
METHODS
Women who underwent BCS for invasive breast cancer at Amsterdam UMC (January 2016-March 2023) were included. Data were retrieved from records, and cross-sectional QoL and cosmetic outcomes were assessed using EORTC-QLQ-C30, -BR23, HADS and BREAST-Q questionnaires. Descriptive statistics were stratified by NST use, with sensitivity analyses for robustness. Excess healthy tissue removal was defined by the calculated resection ratio (CRR) (derived from excision volume and tumor diameter).
RESULTS
Among 403 patients, 136 (33.7%) received NST. Median pathological (postoperative) tumor size was smaller in the NST group (7 mm vs. 14 mm, < 0.001). NST was associated with smaller total resection volumes (TRVs) in patients with cT2 (35 cm vs. 53 cm, = 0.005), and HER2-positive tumors (20 cm vs. 79 cm, = 0.048). CCRs were higher (2.2 vs. 1.6, < 0.002), and radiotherapy boost volume were lower (55 cm vs. 91 cm, = 0.009) following NST. Additionally, fewer patients in the NST group reported acute breast pain (16% vs. 20%, = 0.029). Breast satisfaction scores according to the Breast-Q were 9 points higher in the NST group, although not statistically significant ( = 0.157).
CONCLUSION
NST reduced TRVs in cT2 and HER2-positive tumors, and decreased radiotherapy boost volumes in all patients. However, it was also associated with increased removal of healthy breast tissue. Despite this, NST as associated with less acute breast pain and clinically meaningful improvements in breast satisfaction.
CLINICAL TRIAL NUMBER
Not applicable.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s12885-025-14438-9.
引言
新辅助全身治疗（NST）可能导致肿瘤非同心性缩小，使切除体积的确定变得复杂，并可能增加放疗增敏体积，影响美容效果。本研究旨在比较接受NST与未接受NST的保乳手术（BCS）患者的切除体积和增敏体积，并评估其与生活质量（QoL）和美容效果的相关性。
方法
纳入2016年1月至2023年3月在阿姆斯特丹大学医学中心接受浸润性乳腺癌BCS的女性。数据从记录中获取，并使用欧洲癌症研究与治疗组织生活质量问卷（EORTC-QLQ-C30、-BR23）、医院焦虑抑郁量表（HADS）和乳房-Q问卷评估横断面QoL和美容效果。描述性统计按NST使用情况分层，并进行敏感性分析以确保稳健性。通过计算切除率（CRR）（由切除体积和肿瘤直径得出）定义健康组织切除过多情况。
结果
403例患者中，136例（33.7%）接受了NST。NST组的中位病理（术后）肿瘤大小较小（7毫米对14毫米，<0.001）。NST与cT2期患者（35立方厘米对53立方厘米，P = 0.005）和HER2阳性肿瘤患者（20立方厘米对79立方厘米，P = 0.048）的总切除体积（TRV）较小有关。NST后CRR较高（2.2对1.6，<0.002），放疗增敏体积较低（55立方厘米对91立方厘米，P = 0.009）。此外，NST组报告急性乳房疼痛的患者较少（16%对20%，P = 0.029）。根据乳房-Q问卷，NST组的乳房满意度得分高9分，尽管无统计学意义（P = 0.157）。
结论
NST减少了cT2期和HER2阳性肿瘤的TRV，并降低了所有患者的放疗增敏体积。然而，它也与健康乳腺组织切除增加有关。尽管如此，NST与较少的急性乳房疼痛以及乳房满意度的临床意义改善相关。
临床试验编号
不适用。
补充信息
在线版本包含可在10.1186/s12885-025-14438-9获取的补充材料。
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