Liu Jiaxing, Tan Likuan, Zhang Hongyu, Ma Chengzhi, Qin Gang, Huang Shaolong, Long Yang, He Feng-Hui, Huang Yao, Jiao Miao-Miao, Liu Yufei, Wang Guanghui
Department of Breast and Thyroid Surgery, Tongren People's Hospital, Guizhou, 554300, People's Republic of China.
Department of Breast Surgery, Guizhou Provincial People's Hospital, Guizhou, 550002, People's Republic of China.
Sci Rep. 2025 Aug 18;15(1):30201. doi: 10.1038/s41598-025-14012-0.
Breast cancer is the most common malignant tumor among women worldwide. Hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer is the largest subgroup among these cases. The application of neoadjuvant chemotherapy (NACT) has rapidly increased in recent years, but its impact on long-term survival in HR+/HER2- breast cancer remains debated. This retrospective cohort study analyzed 21,299 stage II-III HR+/HER2- breast cancer patients from the SEER database (2010-2021), employing propensity score matching (PSM) to balance intergroup differences. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to identify significant prognostic factors. Among 21,299 patients, 17.8% received NACT. After propensity score matching (PSM; n = 6,930), the NACT group still showed poorer OS (5-year 83.7% vs. 89.6%; 10-year 69.9% vs. 76.7%; P < 0.001) and BCSS (85.9% vs. 91.6%; 10-year 75.3% vs. 81.8%; P < 0.001). Multivariate analysis confirmed NACT as an independent risk factor for mortality (HR 1.44, 95% CI 1.30-1.59, p < 0.001). Notably, achieving Pathological Complete Response (pCR) (17.3% of NACT patients) did not improve survival, while non-pCR patients had worse outcomes than adjuvant chemotherapy (ACT) recipients (OS HR 1.58, BCSS HR 1.68, p < 0.001). Stratified analyses revealed consistent survival disadvantages for NACT in stage IIB-IIIC, T1-T3, and N0-N2 subgroups. For stage III patients undergoing Breast-Conserving Surgery(BCS), NACT was associated with significantly lower OS and BCSS compared to ACT. NACT in stage II-III HR+/HER2- breast cancer is associated with inferior long-term survival outcomes compared to ACT, particularly in patients with T1-T3 tumors or N0-N2 lymph node involvement. While NACT may enhance BCS rates, its use should be cautiously weighed against potential survival trade-offs. These findings highlight the need for personalized treatment strategies and further validation through prospective trials, especially given the limitations of retrospective SEER data.
乳腺癌是全球女性中最常见的恶性肿瘤。激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）乳腺癌是这些病例中最大的亚组。近年来，新辅助化疗（NACT）的应用迅速增加，但其对HR+/HER2-乳腺癌长期生存的影响仍存在争议。这项回顾性队列研究分析了来自监测、流行病学和最终结果（SEER）数据库（2010 - 2021年）的21299例II - III期HR+/HER2-乳腺癌患者，采用倾向评分匹配（PSM）来平衡组间差异。使用Kaplan - Meier生存分析和Cox比例风险回归来确定显著的预后因素。在21299例患者中，17.8%接受了NACT。经过倾向评分匹配（PSM；n = 6930）后，NACT组的总生存期（OS）仍然较差（5年生存率83.7%对89.6%；10年生存率69.9%对76.7%；P < 0.001）和无乳腺癌生存率（BCSS）（85.9%对91.6%；1年生存率75.3%对81.8%；P < 0.001）。多因素分析证实NACT是死亡的独立危险因素（风险比[HR] 1.44，95%置信区间[CI] 1.30 - 1.59，P < 0.001）。值得注意的是，达到病理完全缓解（pCR）（NACT患者中的17.3%）并未改善生存，而非pCR患者的预后比接受辅助化疗（ACT）的患者更差（OS HR 1.58，BCSS HR 1.68，P < 0.001）。分层分析显示，在IIB - IIIC期、T1 - T3期和N0 - N2亚组中，NACT的生存劣势一致。对于接受保乳手术（BCS）的III期患者，与ACT相比，NACT与显著更低的OS和BCSS相关。与ACT相比，II - III期HR+/HER2-乳腺癌患者接受NACT的长期生存结果较差，特别是在T1 - T3肿瘤或N0 - N2淋巴结受累的患者中。虽然NACT可能提高BCS率，但其使用应谨慎权衡潜在的生存权衡。这些发现凸显了个性化治疗策略的必要性以及通过前瞻性试验进行进一步验证的需求，特别是考虑到回顾性SEER数据的局限性。
