II-III 期乳腺癌患者新辅助化疗与手术后 5 年和 10 年的结局

Introduction : Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods : A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results : The pCR rate was 25. 3% and was greater in HER2 (51. 3%) and TNBC (31. 7%) and in BRCA carriers (41. 9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0. 5 (95%CI 0. 1-1. 4).

Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81. 2% compared to 74. 7%), whereas that for TNBC was 75. 3 and 73. 5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95. 5% vs. 72. 4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.

6%, 69% and 49. 2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42. 9% vs. 79. 7% for ductal carcinomas, p = 0. 001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59. 2% vs. 83.

6% for those patients without vascular invasion, p < 0. 001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89. 6% vs. 77. 2% for non-carriers, p = 0. 054. Conclusions : Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.