Abstract：
OBJECTIVE: Neoadjuvant systemic therapy (NAT) in breast cancer can make tumors resectable or reduce the extent of surgery needed for locally advanced cancers. It can also better prevent distant relapse and possibly modulate drug therapy by adjusting adjuvant therapy (AD) based on the response to NAT, either by escalating or de-escalating the treatment. However, clear evidence of improved outcomes is currently missing. Here, we report on breast cancer patients treated with NAT at our institution.
METHODS: One hundred twenty-seven patients treated at our Radiation Oncology department between 2004 and 2021 were retrospectively analyzed. All patients had localized or locally advanced breast cancer, were treated with NAT, and received postoperative radiotherapy. The outcomes considered were overall survival (OS), loco-regional recurrence-free survival (LRRFS), and distant metastases-free survival (DMFS). A matched patient population treated with AD during the same period and at the same center was used for comparison.
RESULTS: The 5-year predicted OS was 87% in the NAT group and 81.5% in the AD group (p-value=0.179), while LRRFS was 93.2% in the NAT group and 100% in the AD group (p=0.005). The 5-year predicted DMFS was 84.6% in the NAT group and 82.1% in AD patients (p=0.367). In the NAT group, the only prognostic factor significantly related to improved outcomes was the pathological node response, with an OS of 95.6% in patients without residual node disease compared to 75.1% in patients with evidence of residual node disease.
CONCLUSIONS: Our study, despite the limitations of a small number of patients and its retrospective nature, confirms the data of previous larger studies. In terms of DMFS and OS, NAT is at least as effective as AD. NAT represents a great opportunity for personalized modulation of treatment in node-positive breast cancer patients.
METHODS: One hundred twenty-seven patients treated at our Radiation Oncology department between 2004 and 2021 were retrospectively analyzed. All patients had localized or locally advanced breast cancer, were treated with NAT, and received postoperative radiotherapy. The outcomes considered were overall survival (OS), loco-regional recurrence-free survival (LRRFS), and distant metastases-free survival (DMFS). A matched patient population treated with AD during the same period and at the same center was used for comparison.
RESULTS: The 5-year predicted OS was 87% in the NAT group and 81.5% in the AD group (p-value=0.179), while LRRFS was 93.2% in the NAT group and 100% in the AD group (p=0.005). The 5-year predicted DMFS was 84.6% in the NAT group and 82.1% in AD patients (p=0.367). In the NAT group, the only prognostic factor significantly related to improved outcomes was the pathological node response, with an OS of 95.6% in patients without residual node disease compared to 75.1% in patients with evidence of residual node disease.
CONCLUSIONS: Our study, despite the limitations of a small number of patients and its retrospective nature, confirms the data of previous larger studies. In terms of DMFS and OS, NAT is at least as effective as AD. NAT represents a great opportunity for personalized modulation of treatment in node-positive breast cancer patients.
摘要：
目的：乳腺癌的新辅助系统治疗（NAT）可以使肿瘤可切除或减少局部晚期癌症所需的手术范围。它还可以更好地预防远处复发，并可能通过根据对NAT的反应调整辅助治疗（AD）来调节药物治疗。通过升级或降级治疗。然而,目前缺少改善结局的明确证据.这里,我们报告了在我们机构接受NAT治疗的乳腺癌患者。
方法：回顾性分析了2004年至2021年在我们放射肿瘤科接受治疗的127例患者。所有患者均患有局部或局部晚期乳腺癌，用NAT处理，术后接受放疗。考虑的结果是总生存期（OS），局部区域无复发生存率（LRRFS），和无远处转移生存期（DMFS）。在同一时期和同一中心用AD治疗的匹配患者群体用于比较。
结果：5年预测的OS在NAT组中为87％，在AD组中为81.5％（p值=0.179），NAT组LRRFS为93.2%,AD组为100%(p=0.005)。NAT组的5年预测DMFS为84.6%，AD患者为82.1%(p=0.367)。在NAT组中，唯一与改善预后显着相关的预后因素是病理淋巴结反应，无残留淋巴结疾病患者的OS为95.6%，而有残留淋巴结疾病证据的患者为75.1%。
结论：我们的研究，尽管少数患者的局限性及其回顾性性质，证实了以前较大研究的数据。在DMFS和OS方面，NAT至少和AD一样有效。NAT代表了在节点阳性乳腺癌患者中个性化调节治疗的绝佳机会。
方法：回顾性分析了2004年至2021年在我们放射肿瘤科接受治疗的127例患者。所有患者均患有局部或局部晚期乳腺癌，用NAT处理，术后接受放疗。考虑的结果是总生存期（OS），局部区域无复发生存率（LRRFS），和无远处转移生存期（DMFS）。在同一时期和同一中心用AD治疗的匹配患者群体用于比较。
结果：5年预测的OS在NAT组中为87％，在AD组中为81.5％（p值=0.179），NAT组LRRFS为93.2%,AD组为100%(p=0.005)。NAT组的5年预测DMFS为84.6%，AD患者为82.1%(p=0.367)。在NAT组中，唯一与改善预后显着相关的预后因素是病理淋巴结反应，无残留淋巴结疾病患者的OS为95.6%，而有残留淋巴结疾病证据的患者为75.1%。
结论：我们的研究，尽管少数患者的局限性及其回顾性性质，证实了以前较大研究的数据。在DMFS和OS方面，NAT至少和AD一样有效。NAT代表了在节点阳性乳腺癌患者中个性化调节治疗的绝佳机会。
