Ipsilateral breast tumor recurrence (IBTR) in patients with operable breast cancer who undergo breast-conserving treatment after receiving neoadjuvant chemotherapy
Ipsilateral breast tumor recurrence (IBTR) in patients with operable breast cancer who undergo breast-conserving treatment after receiving neoadjuvant chemotherapy
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DOI：
10.1002/cncr.27377
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发表时间：
2012-09-15
期刊：
影响因子：
6.2
通讯作者：
Oura, Shoji
中科院分区：
文献类型：
--
作者：
Ishitobi, Makoto;Ohsumi, Shozo;Oura, Shoji
背景：关于新辅助化疗（NAC）后接受保乳手术加放疗（保乳治疗[BCT]）的患者同侧乳腺肿瘤复发（IBTR）危险因素的信息有限。当前研究的目的是分析这些风险因素。方法：作者收集了 375 名接受 BCT 并接受 NAC 的患者的数据，并分析了与 NAC 后接受 BCT 相关的 IBTR 风险。 MD 安德森预后指数 (MDAPI) 对 IBTR 的有用性也使用当前数据集进行了验证。结果：中位随访时间为47.8个月，4年无IBTR生存率为95.6%。多变量分析表明，雌激素受体 (ER) 状态和残留肿瘤的多灶性与无 IBTR 生存显着相关。此外，ER阳性和人表皮生长因子2（HER2）阴性肿瘤的患者在观察期间没有发生IBTR。虽然根据MDAPI进行预后分层对于研究患者IBTR的预测相对较好，但高危组的IBTR率并不是很高，并且低于中危组。多变量分析表明 IBTR 是总生存率的独立预测因素。结论：ER 状态和 NAC 后残留肿瘤的多灶性是 BCT 后 IBTR 的独立预测因素。 MDAPI 在预测 IBTR 方面几乎不适合研究患者。 ER 阳性和 HER2 阴性肿瘤患者预后良好，而 NAC 后发生 IBTR 的患者总体生存率明显较差。作者提出了一种新的 IBTR 预后指数，该指数使用了 2 个被确定为 IBTR 预测因素的因素：ER 状态和残留肿瘤的多灶性。癌症 2012。(c) 2012 美国癌症协会。
BACKGROUND: There is limited information about the risk factors for ipsilateral breast tumor recurrence (IBTR) after patients undergo breast-conserving surgery plus radiotherapy (breast-conserving treatment [BCT]) subsequent to neoadjuvant chemotherapy (NAC). The objective of the current study was to analyze these risk factors. METHODS: The authors collected data from 375 patients who underwent BCT and received NAC and analyzed the risk of IBTR associated with undergoing BCT after NAC. The usefulness of the MD Anderson Prognostic Index (MDAPI) for IBTR also was validated using the current data set. RESULTS: The median follow-up was 47.8 months, and the 4-year IBTR-free survival rate was 95.6%. Multivariate analysis demonstrated that estrogen receptor (ER) status and multifocality of the residual tumor were associated significantly with IBTR-free survival. In addition, patients who had ER-positive and human epidermal growth factor 2 (HER2)-negative tumors did not develop IBTR during the observation period. Although prognostic stratification according to MDAPI was relatively good for the prediction of IBTR in the study patients, the IBTR rate in the high-risk group was not very high and was lower than that in the intermediate-risk group. Multivariate analyses demonstrated that IBTR was an independent predictive factor for overall survival. CONCLUSIONS: ER status and multifocality of the residual tumor after NAC were independent predictors of IBTR after BCT. The MDAPI was barely adaptable to the study patients in terms of predicting IBTR. Patients with ER-positive and HER2-negative tumors had a favorable prognosis, whereas patients who developed IBTR after NAC had significantly worse overall survival. The authors propose a new IBTR prognostic index using the 2 factors that were identified as predictive of IBTR: ER status and multifocality of the residual tumor. Cancer 2012. (c) 2012 American Cancer Society.