Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response.Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan–Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion.Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1–1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR,p< 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively,p< 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas,p= 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion,p< 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers,p= 0.054.Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.
引言：乳腺癌新辅助化疗有助于简化乳房及腋窝手术操作；该疗法可作为体内化疗敏感性的检测手段，具有显著预后价值，并能根据治疗反应调整辅助治疗方案。材料与方法：本研究回顾性分析了482例II期和III期乳腺癌患者单中心队列数据，所有患者均接受基于蒽环类和紫杉类药物的新辅助化疗，其中HER2阳性病例加用抗HER2治疗。研究计算了5年及10年生存率，并通过Kaplan-Meier曲线和时序检验分析年龄、BRCA状态、绝经状态、TNM分期、病理及分子亚型、20%肿瘤浸润淋巴细胞临界值、手术方式、化疗反应及脉管侵犯等因素对生存差异的影响。结果：病理完全缓解率为25.3%，其中HER2阳性型（51.3%）和三阴性乳腺癌（31.7%）以及BRCA携带者（41.9%）的缓解率更高。与患者生存独立相关的因素包括病理及分子亚型、手术方式、新辅助化疗反应和脉管侵犯。BRCA状态虽未达到统计学显著性，但呈现保护性预后趋势（HR 0.5，95%CI 0.1-1.4）。乳房切除术的远期复发风险是保乳手术的两倍，支持新辅助化疗后保乳手术的安全性。中位随访126个月（标准差43个月）后，管腔型肿瘤的5年与10年生存率存在显著差异（81.2%对比74.7%），而三阴性乳腺癌分别为75.3%和73.5%。差异最显著体现在病理完全缓解患者中，其10年无远处转移生存率达95.5%，未达病理完全缓解者仅为72.4%（p<0.001）。这种差异在三阴性乳腺癌中尤为突出：根据残留肿瘤负荷0-3分级，10年无远处转移生存率分别为100%、80.6%、69%和49.2%（p<0.001）。预后特别不良的群体包括小叶癌患者（10年无远处转移生存率42.9%，导管癌79.7%，p=0.001）以及手术标本存在脉管侵犯者（10年无远处转移生存率59.2%，无脉管侵犯者83.6%，p<0.001）。值得注意的是，BRCA携带者生存期更长，预估10年无远处转移生存率达89.6%，非携带者为77.2%（p=0.054）。结论：新辅助化疗的长期疗效数据可为患者和临床医生提供精准决策依据。
肿瘤(癌症)患者之家