Impact of timeliness of adjuvant chemotherapy and radiotherapy on the outcomes of breast cancer; a pooled analysis of three clinical trials
Impact of timeliness of adjuvant chemotherapy and radiotherapy on the outcomes of breast cancer; a pooled analysis of three clinical trials
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DOI：
10.1016/j.breast.2018.01.010
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发表时间：
2018-04-01
期刊：
影响因子：
3.9
通讯作者：
Abdel-Rahman, Omar
中科院分区：
文献类型：
--
作者：
Abdel-Rahman, Omar
目的：评估延迟辅助化疗和/或放疗对转诊为辅助治疗的乳腺癌患者预后的影响。方法：对3个临床试验中3390例转诊为辅助化疗的乳腺癌患者的患者水平数据进行汇总分析。通过Kaplan-Meier分析，根据“手术至化疗间隔”评估总体和无复发生存率。同样，在接受辅助放射治疗的患者中，通过Kaplan-Meier分析，根据手术到放射治疗的间隔时间来评估无复发生存率。结果：采用Kaplan-Meier方法对手术至化疗间隔(<；vs.>；6周)的总生存率进行Kaplan-Meier分析。当按激素受体状态分层时，间隔时间越长，激素受体阴性患者的总体生存越差(P=0.006)；而激素受体阳性患者的总体生存差异与间隔时间越长越不相关(P=0.268)。在多因素COX回归分析中，“手术至化疗间隔”与激素受体状态的交互作用检验有统计学意义(P=0.015)。此外，当多因素分析仅限于激素受体阴性的患者时，在这类患者中，手术至化疗间隔时间越长，总体生存率越差(P=0.004)。另一方面，在影响无复发生存率的多因素分析中，手术至放疗间隔时间并不影响无复发生存率(P=0.439)。结论：在激素受体阴性的患者中，延迟化疗开始时间超过6周(术后)与患者预后较差有关。此外，推迟手术后开始放射治疗不会影响接受长程辅助化疗的患者的预后。(C)2018爱思唯尔有限公司。保留所有权利。
Objective: To assess the impact of delay in initiation of adjuvant chemotherapy and/or radiotherapy on the outcomes of breast cancer patients referred for adjuvant treatment.Methods: This is a pooled analysis of patient-level data of 3390 breast cancer patients referred for adjuvant chemotherapy in three clinical trials. Overall and relapse-free survivals were assessed according to "surgery to chemotherapy interval" through Kaplan-Meier analysis. Likewise, among patients who received adjuvant radiotherapy, relapse-free survival was assessed according to "surgery to radiotherapy interval" through Kaplan-Meier analysis. Univariate and Multivariate analysis of factors affecting overall and relapse-free survival was then conducted through Cox regression analysis.Results: Kaplan-Meier analysis of overall survival according to surgery to chemotherapy interval (< vs. > 6 weeks) was conducted. When stratified by the hormone receptor status, the longer interval was associated with worse overall survival in hormone receptor-negative patients (P = 0.006); while it was not associated with overall survival difference in hormone receptor-positive patients (P = 0.268). In multivariate Cox regression analysis, the test of interaction between "surgery to chemotherapy interval" and hormone receptor status was significant (P = 0.015). Moreover, when the multivariate analysis was restricted to hormone receptor-negative patients, longer surgery to chemotherapy interval was associated with worse overall survival among this subset of patients (P = 0.004). On the other hand, in multivariate analysis of factors affecting relapse-free survival, surgery to radiotherapy interval did not impact relapse-free survival (P = 0.439).Conclusion: Among hormone receptor-negative patients, delaying chemotherapy initiation beyond 6 weeks (after surgery) is associated with worse patient outcomes. Moreover, delaying radiotherapy initiation beyond surgery does not compromise outcomes in patients receiving long course adjuvant chemotherapy. (c) 2018 Elsevier Ltd. All rights reserved.