Backgrounds: Neoadjuvant therapy (NAT) is a cornerstone in the management of breast cancer (BC), enabling tumor downstaging and improved surgical options. Methods: This study retrospectively analyzed 607 BC patients treated with NAT and surgery at IRCCS Humanitas Research Hospital, Milan, Italy, to compare long-term oncologic outcomes of breast-conserving surgery (BCS) versus mastectomy. Patient demographics, tumor characteristics, and treatment details were analyzed using descriptive statistics, logistic regression, and Cox proportional hazards models. Results: Of the 607 patients, 54.7% underwent BCS, and 45.3% had mastectomy. BCS was associated with significantly superior 10-year outcomes compared to mastectomy, including disease-free survival (DFS, 75.2% vs. 71.1%,p= 0.001), distant DFS (75.2% vs. 71.1%,p= 0.001), overall survival (OS, 82.9% vs. 78.1%,p= 0.002), and BC-specific survival (BCSS, 87.7% vs. 83.1%,p= 0.001). Pathologic complete response (pCR) emerged as a protective factor across all endpoints, while mastectomy was independently associated with worse BCSS (HR: 2.068, 95% CI: 1.016–4.210,p= 0.045). Conclusions: Our findings demonstrate the oncologic safety and potential superiority of BCS over mastectomy in NAT-treated BC patients, highlighting the importance of individualized surgical decision-making to optimize survival outcomes.
背景：新辅助治疗（NAT）是乳腺癌（BC）管理的基石，可实现肿瘤降期并改善手术选择。方法：本研究回顾性分析了意大利米兰IRCCS Humanitas研究医院接受NAT及手术治疗的607例BC患者，比较保乳手术（BCS）与乳房切除术的长期肿瘤学结局。采用描述性统计、逻辑回归和Cox比例风险模型分析患者人口统计学特征、肿瘤特点及治疗细节。结果：在607例患者中，54.7%接受BCS，45.3%接受乳房切除术。与乳房切除术相比，BCS在10年结局方面表现出显著优势，包括无病生存率（DFS，75.2% vs. 71.1%，p=0.001）、无远处转移生存率（75.2% vs. 71.1%，p=0.001）、总生存率（OS，82.9% vs. 78.1%，p=0.002）及乳腺癌特异性生存率（BCSS，87.7% vs. 83.1%，p=0.001）。病理完全缓解（pCR）是所有终点事件的保护性因素，而乳房切除术与较差的BCSS独立相关（HR：2.068，95% CI：1.016–4.210，p=0.045）。结论：我们的研究结果表明，在接受NAT治疗的BC患者中，BCS相较于乳房切除术具有肿瘤学安全性及潜在优势，强调了个体化手术决策对优化生存结局的重要性。
肿瘤(癌症)患者之家