Objectives:To evaluate the neoadjuvant chemotherapy (NACTx) process in breast cancer (BC), its significant treatment-related adverse events (trAEs), tumor clinical response rates, and surgical and pathological outcomes, and to analyze factors influencing cavity shaving and axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB).Methods:A comprehensive retrospective study was conducted at a single center on patients who received NACTx for BC between 2015 and 2021.Results:Medical records of 242 patients were reviewed. Approximately one-fifth encountered grade ≥ 3 trAEs (21.5%), leading 3.3% to discontinue chemotherapy. Anthracycline cardiotoxicity (2.2%) caused one death (mortality rate = 0.4%). For clinical response and surgical and pathological outcomes, 229 patients were eligible. Clinical progression occurred in 3.9% of the patients (14% in triple-negative BC,p= 0.004). Breast-conserving surgery (BCS) was performed in 55% of the patients. There was no significant difference between the type of breast surgery (BCS vs. mastectomy) and molecular subtype, histology, tumor size, or tumor’s pathological response degree. Cavity shaving was required in one-fifth of the patients who underwent BCS (n = 134) due to an invasive tumor at the surgical margin (SM). Tumor histology (invasive ductal vs. invasive lobular carcinoma; OR: 4.962, 95% CI 1.007–24.441,p= 0.049) and tumor SUVMax value (OR: 0.866, 95% CI 0.755–0.993,p= 0.039) had significant independent efficacy on SM positivity. Initially, 75% underwent SLNB, but nearly half of them needed ALND. ALND rates were significantly higher in the luminal A and LB-HER2(−) groups (87% vs. 69%) than in the HER2(+) and TN groups (43% to 50%) (p= 0.001). All luminal A patients and those with lobular histology required ALND after SLNB, but no patients in the HER2-enriched group required ALND. ER positivity and higher PR expression levels were associated with an increased need for ALND after SLNB, whereas HER2 positivity and higher SUVMax values of LN(s) were associated with a significantly reduced need for ALND. About 27% of the patients achieved overall pCR. No pCR was achieved in the LA group.Conclusions:The BC NACTx process requires close monitoring due to severe AEs and disease progression. NACTx decisions must be made on experienced multidisciplinary tumor boards, considering tumor characteristics and expected targets.
目的：评估乳腺癌新辅助化疗过程、其显著的治疗相关不良事件、肿瘤临床缓解率以及手术与病理学结果，并分析影响前哨淋巴结活检后残腔切缘补充切除及腋窝淋巴结清扫的因素。 方法：对2015年至2021年间接受新辅助化疗的乳腺癌患者进行单中心综合性回顾研究。 结果：共纳入242例患者病历资料。约五分之一患者出现≥3级治疗相关不良事件（21.5%），其中3.3%因此终止化疗。蒽环类药物心脏毒性事件发生率为2.2%，导致1例死亡（死亡率=0.4%）。在临床缓解及手术病理结果评估中，229例患者符合分析条件。3.9%患者出现临床进展（三阴性乳腺癌中达14%，p=0.004）。55%患者接受保乳手术。保乳手术与乳房切除术在分子亚型、组织学类型、肿瘤大小或肿瘤病理缓解程度方面均无显著差异。在接受保乳手术的患者中（n=134），因手术切缘存在浸润性肿瘤，五分之一患者需行残腔切缘补充切除。肿瘤组织学类型（浸润性导管癌 vs. 浸润性小叶癌；OR：4.962，95% CI 1.007–24.441，p=0.049）及肿瘤SUVMax值（OR：0.866，95% CI 0.755–0.993，p=0.039）对切缘阳性状态具有显著独立影响。初始75%患者接受前哨淋巴结活检，其中近半数需补充腋窝淋巴结清扫。管腔A型与LB-HER2(−)组腋窝淋巴结清扫率（87% vs. 69%）显著高于HER2(+)与三阴性组（43%至50%）（p=0.001）。所有管腔A型患者及小叶组织学类型患者在前哨淋巴结活检后均需腋窝淋巴结清扫，而HER2过表达组无患者需行该手术。ER阳性及更高PR表达水平与前哨淋巴结活检后腋窝淋巴结清扫需求增加相关，而HER2阳性及更高淋巴结SUVMax值则与清扫需求显著降低相关。约27%患者达到总体病理完全缓解，管腔A型组未出现病理完全缓解病例。 结论：乳腺癌新辅助化疗过程因严重不良事件及疾病进展风险需密切监测。治疗决策应在经验丰富的多学科肿瘤委员会指导下制定，需综合考虑肿瘤特征与预期治疗目标。
肿瘤(癌症)患者之家