Predictors of Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From Combined Analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27
Predictors of Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From Combined Analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27
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DOI：
10.1200/jco.2011.40.8369
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发表时间：
2012-11-10
影响因子：
45.3
通讯作者：
Wolmark, Norman
中科院分区：
文献类型：
--
作者：
Mamounas, Eleftherios P.;Anderson, Stewart J.;Wolmark, Norman
PurposeThe有限的信息预测局部复发（LRR）后，新辅助化疗（NC）的最佳使用的辅助放疗和前哨淋巴结活检的时间引起了争议。Patients and MethodsWe检查的模式和预测LRR作为第一个事件的两个国家外科辅助乳腺和肠道项目（NSABP）新辅助试验的联合分析。NC为单独的多柔比星/环磷酰胺（AC）或AC随后为新辅助/辅助多西他赛。肿块切除术患者仅接受乳房放疗;乳房切除术患者未接受放疗。病理学完全缓解定义为乳腺中没有浸润性肿瘤。多变量分析用于确定LRR的独立预测因子。主要终点是时间LRR作为第一events.ResultsIn 3，088例患者，335 LRR事件发生后10年的随访。乳房切除术患者的10年累积LRR发生率为12.3%（局部8.9%;区域3.4%），乳房肿瘤切除术加乳房放疗患者的10年累积LRR发生率为10.3%（局部8.1%;区域2.2%）。在乳房肿瘤切除术患者中，LRR的独立预测因素是年龄、临床淋巴结状态（NC前）和病理淋巴结状态/乳腺肿瘤反应;在乳房切除术患者中，它们是临床肿瘤大小（NC前）、临床淋巴结状态（NC前）和病理淋巴结状态/乳腺肿瘤反应。通过使用这些独立的预测因子，可以确定LRR的低、中和高风险组。诺模图，将这些独立的predictorseduced.ConclusionIn患者治疗NC，年龄，临床肿瘤特征前NC，病理淋巴结状态/乳腺肿瘤反应后NC可用于预测风险LRR和优化使用辅助放疗。J Clin Oncol 30：3960-3966. (C)2012年美国临床肿瘤学会
PurposeThe limited information on predictors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NC) has resulted in controversy about the optimal use of adjuvant radiotherapy and the timing of sentinel lymph node biopsy.Patients and MethodsWe examined patterns and predictors of LRR as first event in combined analysis of two National Surgical Adjuvant Breast and Bowel Project (NSABP) neoadjuvant trials. NC was either doxorubicin/cyclophosphamide (AC) alone or AC followed by neoadjuvant/adjuvant docetaxel. Lumpectomy patients received breast radiotherapy alone; mastectomy patients received no radiotherapy. Pathologic complete response was defined as the absence of invasive tumor in the breast. Multivariate analyses were used to identify independent predictors of LRR. The primary end point was time to LRR as first event.ResultsIn 3,088 patients, 335 LRR events had occurred after 10 years of follow-up. The 10-year cumulative incidence of LRR was 12.3% for mastectomy patients (8.9% local; 3.4% regional) and 10.3% for lumpectomy plus breast radiotherapy patients (8.1% local; 2.2% regional). Independent predictors of LRR in lumpectomy patients were age, clinical nodal status (before NC), and pathologic nodal status/breast tumor response; in mastectomy patients, they were clinical tumor size (before NC), clinical nodal status (before NC), and pathologic nodal status/breast tumor response. By using these independent predictors, groups at low, intermediate, and high risk of LRR could be identified. Nomograms that incorporate these independent predictors were created.ConclusionIn patients treated with NC, age, clinical tumor characteristics before NC, and pathologic nodal status/breast tumor response after NC can be used to predict risk for LRR and to optimize the use of adjuvant radiotherapy. J Clin Oncol 30:3960-3966. (C) 2012 by American Society of Clinical Oncology