Pathologic Complete Response after Neoadjuvant Chemotherapy and Impact on Breast Cancer Recurrence and Survival: A Comprehensive Meta-analysis
Pathologic Complete Response after Neoadjuvant Chemotherapy and Impact on Breast Cancer Recurrence and Survival: A Comprehensive Meta-analysis
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DOI：
10.1158/1078-0432.ccr-19-3492
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发表时间：
2020-06-01
影响因子：
11.5
通讯作者：
Bardia, Aditya
中科院分区：
文献类型：
--
作者：
Spring, Laura M.;Fell, Geoffrey;Bardia, Aditya
目的：虽然各种研究都强调了新辅助化疗（NAT）后病理完全缓解（pCR）的预后意义，但pCR后额外辅助治疗的影响尚不清楚。实验设计：检索PubMed中与乳腺癌相关的NAT研究，并提取个体患者水平的数据，使用绘图数字化软件进行分析。hr采用95%概率区间（PI），测量pCR与总生存期（OS）或无事件生存期（EFS）之间的关联，使用贝叶斯分段指数比例风险分层模型（包括pCR作为预测因子）估计。结果：总体而言，3209篇出版物中有52篇符合纳入标准，共计27,895例患者。NAT后pCR患者的EFS明显改善（HR = 0.31; 95% PI, 0.24-0.39），特别是对于三阴性（HR = 0.18; 95% PI, 0.10-0.31）和HER2(+) （HR = 0.32; 95% PI, 0.21-0.47）疾病。同样，NAT后的pCR也与生存率的提高相关（HR = 0.22; 95% PI, 0.15-0.30）。随后接受辅助化疗的患者（HR = 0.36, 95% PI, 0.19-0.67）与未接受辅助化疗的患者（HR = 0.36, 95% PI, 0.27-0.54）的pCR与改善EFS的相关性相似，两组间差异无统计学意义（P = 0.60）。结论：在NAT后进行pCR与更好的EFS和OS相关，特别是对于三阴性和HER2（+）乳腺癌。在获得pCR的患者中，接受或不接受辅助化疗的类似结果可能反映了肿瘤生物学和微转移性疾病的全身清除，突出了基于新辅助反应的辅助治疗中升级/降级策略的潜力。见埃塞曼的相关评论，第2771页。
Purpose: While various studies have highlighted the prognostic significance of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAT), the impact of additional adjuvant therapy after pCR is not known.Experimental Design: PubMed was searched for studies with NAT for breast cancer and individual patient-level data was extracted for analysis using plot digitizer software. HRs, with 95% probability intervals (PI), measuring the association between pCR and overall survival (OS) or event-free survival (EFS), were estimated using Bayesian piece-wise exponential proportional hazards hierarchical models including pCR as predictor.Results: Overall, 52 of 3,209 publications met inclusion criteria, totaling 27,895 patients. Patients with a pCR after NAT had significantly better EFS (HR = 0.31; 95% PI, 0.24-0.39), particularly for triple-negative (HR = 0.18; 95% PI, 0.10-0.31) and HER2(+) (HR = 0.32; 95% PI, 0.21-0.47) disease. Similarly, pCR after NAT was also associated with improved survival (HR = 0.22; 95% PI, 0.15-0.30). The association of pCR with improved EFS was similar among patients who received subsequent adjuvant chemotherapy (HR = 0.36; 95% PI, 0.19-0.67) and those without adjuvant chemotherapy (HR = 0.36; 95% PI, 0.27-0.54), with no significant difference between the two groups (P = 0.60).Conclusions: Achieving pCR following NAT is associated with significantly better EFS and OS, particularly for triple-negative and HER2(+) breast cancer. The similar outcomes with or without adjuvant chemotherapy in patients who attain pCR likely reflects tumor biology and systemic clearance of micrometastatic disease, highlighting the potential of escalation/deescalation strategies in the adjuvant setting based on neoadjuvant response. See related commentary by Esserman, p. 2771.