Neoadjuvant Chemotherapy Plays an Adverse Role in the Prognosis of Grade 2 Breast Cancer
Neoadjuvant Chemotherapy Plays an Adverse Role in the Prognosis of Grade 2 Breast Cancer
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DOI：
10.7150/jca.33168
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发表时间：
2019-09
影响因子：
3.9
通讯作者：
Xudong Zhu;Jinqi Xue;Xi Gu;Guanglei Chen;F. Cao;Huilian Shan;Dan Wang;Xinbo Qiao;Caigang Liu;Yixiao Zhang
中科院分区：
文献类型：
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作者：
Xudong Zhu;Jinqi Xue;Xi Gu;Guanglei Chen;F. Cao;Huilian Shan;Dan Wang;Xinbo Qiao;Caigang Liu;Yixiao Zhang
背景：新辅助化疗 (NAC) 在 2 级肿瘤患者乳腺癌预后中的作用尚不清楚。因此，我们的目的是探讨 NAC 与 2 级乳腺癌患者生存结果之间的关系。材料和方法：我们收集了 726 名患有 2 级肿瘤的乳腺癌患者的数据，并从诊断之日起进行了至少 5 年的随访。然后，我们进行了生存分析，以检查 NAC 与无病生存 (DFS) 和总生存 (OS) 之间的关联。在亚组分析中进一步研究了 NAC 在预后中的作用，根据分子亚型、组织学分级、ER 状态、PR 状态、HER2 状态和 Ki67 指数对患者进行分层。我们还确定了接受 NAC 的患者局部复发的主要部位，以及涉及远处转移的器官。最后，我们使用 Cox 回归分析分析了 DFS 和 OS 的独立预测因素。结果：在接受 NAC 治疗的患者中，病理完全缓解 (pCR) 率为 9.87% (23/233)，其中 32.6% (76/233) 的患者出现部分缓解。生存分析表明 NAC 对 DFS 和 OS 具有总体不利影响。亚组分析显示，除三阴性乳腺癌 (TNBC) 患者外，接受 NAC 治疗的患者在所有乳腺癌分子亚组中的 DFS 均较短。 NAC 还与组织学分级为 2 级且 Ki67 指数较低的患者的 OS 较短相关。主要复发部位是胸腔，远处转移发生在骨、肝、肺等部位。在 Cox 回归分析中，我们发现 NAC 是 DFS 的独立预测因子，但不是 OS 的独立预测因子。结论：NAC 可能对 2 级肿瘤患者的乳腺癌预后产生不利影响。这些患者不需要接受NAC，除非患者有强烈的保乳愿望，而在没有NAC的情况下这是不可能实现的。
Background: The role of neoadjuvant chemotherapy (NAC) in the prognosis of breast cancer among patients with grade 2 tumors remains unclear. As such, we aimed to explore the relationships between NAC and survival outcomes among patients with grade 2 breast cancer. Materials and Methods: We collected data on 726 breast cancer patients with grade 2 tumors and at least 5-years of follow-up from the date of diagnosis. We then conducted survival analyses to examine the association between NAC and disease-free survival (DFS) and overall survival (OS). The role of NAC in prognosis was further examined in subgroup analyses, with patients stratified according to molecular subtypes, histological grade, ER status, PR status, HER2 status and Ki67 index. We also determined the main sites of local recurrence, as well as these organs involved in distant metastasis among patients receiving NAC. Finally, we analyzed independent predictive factors for DFS and OS using Cox regression analyses. Results: Among patients who received NAC, the prevalence of pathologic complete response (pCR) was 9.87% (23/233), with 32.6% of patients (76/233) experiencing partial response. Survival analyses demonstrated that NAC had an overall adverse effect on DFS and OS. Subgroup analyses showed that patients who received NAC had shorter DFS in all molecular subgroups of breast cancer, with exception of triple negative breast cancer (TNBC) patients. NAC was also associated with shorter OS among patients with histological grade of 2 and a low Ki67 index. The main recurrence site was the chest well, while distant metastasis occurred in the bone, liver and lung. In Cox regression analyses, we found that NAC was an independent predictor for DFS, but not for OS. Conclusions: NAC may have an adverse effect on breast cancer prognosis among patients with grade 2 tumors. These patients need not receive NAC, except when the patient has a strong desire for breast conservation, and this is unlikely to be achieved in the absence of NAC.