Huynh Victoria, Glencer Alexa, Yi Min, Wingate Emma, Wingate Hannah, Allassan Naid, Alameddine Sarah, Singh Puneet, Kuerer Henry M, Hunt Kelly K, Refinetti Ana Paula
Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Palo Alto Medical Foundation, Mountain View, CA, USA.
Ann Surg Oncol. 2025 Aug 5. doi: 10.1245/s10434-025-18028-8.
We aimed to compare oncologic outcomes between patients achieving pathologic complete response (pCR) versus residual disease (RD) after receiving neoadjuvant systemic therapy (NST) and breast-conserving surgery (BCS).
Our institutional database was used to identify patients treated with NST and BCS for cT1-3N0 invasive breast cancer. Overall survival (OS), disease-specific survival (DSS), local-regional recurrence-free survival (LRRFS), and distant recurrence-free survival (DRFS) rates were compared between patients with pCR and RD. Multivariable analysis was used to identify factors associated with oncologic outcomes.
Between 1999 and 2015, 732 patients received NST and BCS, with a median follow-up period of 7.1 years. Median age at diagnosis was 52 years. Most patients had clinical T2 (78.8%). pCR differed significantly by tumor subtype, with larger proportions of patients with human epidermal growth factor receptor 2-positive (HER2+; 42.9%) and triple-negative (46.2%) breast cancer (TNBC) achieving pCR compared with hormone receptor-positive (HR+)/HER2-negative (HER2-; 15%) disease (p < 0.0001). Patients achieving pCR had significantly improved 5-year OS (p = 0.002), DSS (p = 0.02), and DRFS (p = 0.01) compared with those with RD. There were no significant differences in LRRFS between patients with pCR and RD, and the 5-year LRR rates were low, except in patients with TNBC and RD. On multivariate analyses, oncologic outcomes differed significantly by tumor subtype, with TNBC subtype associated with worse OS, DSS, LRRFS, and DRFS.
pCR is associated with improved OS, DSS, and DFRS. LRR rates were low, regardless of pCR or RD, in all tumor subtypes except TNBC.
我们旨在比较接受新辅助全身治疗（NST）和保乳手术（BCS）后达到病理完全缓解（pCR）与有残留疾病（RD）的患者之间的肿瘤学结局。
利用我们机构的数据库识别接受NST和BCS治疗的cT1-3N0浸润性乳腺癌患者。比较pCR和RD患者的总生存期（OS）、疾病特异性生存期（DSS）、局部区域无复发生存期（LRRFS）和远处无复发生存期（DRFS）率。采用多变量分析确定与肿瘤学结局相关的因素。
1999年至2015年期间，732例患者接受了NST和BCS，中位随访期为7.1年。诊断时的中位年龄为52岁。大多数患者为临床T2期（78.8%）。pCR因肿瘤亚型而异，与激素受体阳性（HR+）/人表皮生长因子受体2阴性（HER2-；15%）疾病相比，人表皮生长因子受体2阳性（HER2+；42.9%）和三阴性（46.2%）乳腺癌（TNBC）患者达到pCR的比例更高（p<0.0001）。与RD患者相比，达到pCR的患者5年OS（p=0.002）、DSS（p=0.02）和DRFS（p=0.01）显著改善。pCR和RD患者之间的LRRFS无显著差异，5年LRR率较低，TNBC和RD患者除外。多变量分析显示，肿瘤学结局因肿瘤亚型而异，TNBC亚型与较差的OS、DSS、LRRFS和DRFS相关。
pCR与改善的OS、DSS和DFRS相关。除TNBC外，所有肿瘤亚型的LRR率均较低，无论pCR或RD情况如何。
