背景:新辅助化疗(NACT)在T2N1M0期激素受体阳性中的应用指南建议,HER2阴性(HR+/HER2-)乳腺癌是模棱两可的。关于NACT或辅助化疗(ACT)是否为这些患者提供更好的生存结果的争论仍在继续。
方法:从监测中确定了2010年至2020年T2N1M0期诊断为HR/HER2-乳腺癌的女性患者,流行病学,和最终结果数据库,并分为两组,NACT组和ACT组。倾向得分匹配(PSM)用于建立组间平衡的队列,考虑基线特征。执行Kaplan-Meier(K-M)分析和Cox比例风险模型以评估NACT和ACT在总生存期(OS)和乳腺癌特异性生存期(BCSS)方面的功效。采用逻辑回归模型来检查预测变量与对NACT的反应之间的关联。
结果:PSM后,最终纳入4,682名患者。K-M曲线显示,与接受ACT的患者相比,接受NACT的患者表现出明显更差的OS和BCSS。多变量Cox分析显示NACT后未达到病理完全缓解(非pCR)(与ACT相比),被确定为OS(HR1.58,95%CI1.36-1.83)和BCSS(HR1.70,95%CI1.44-2)的不良预后因素。02).逻辑回归模型显示,低肿瘤分级独立预测非pCR。
结论:在T2N1M0阶段HR+/HER2-患者中,NACT的OS和BCSS均不如ACT。与接受ACT的患者相比,NACT后获得非pCR的患者表现出明显更差的生存结果。
BACKGROUND: Guideline recommendations for the application of neoadjuvant chemotherapy (NACT) in T2N1M0 stage hormone receptor-positive, HER2-negative (HR + /HER2-) breast cancer are ambiguous. The debate continues regarding whether NACT or adjuvant chemotherapy (ACT) offers superior survival outcomes for these patients.
METHODS: Female patients diagnosed with HR + /HER2- breast cancer at T2N1M0 stage between 2010 and 2020, were identified from the Surveillance, Epidemiology, and End Results database and divided into two groups, the NACT group and the ACT group. Propensity score matching (PSM) was utilized to establish balanced cohorts between groups, considering baseline features. Kaplan-Meier (K-M) analysis and the Cox proportional hazards model were executed to assess the efficacy of both NACT and ACT in terms of overall survival (OS) and breast cancer-specific survival (BCSS). A logistic regression model was employed to examine the association between predictive variables and response to NACT.
RESULTS: After PSM, 4,682 patients were finally included. K-M curves showed that patients receiving NACT exhibited significantly worse OS and BCSS when compared with patients undergoing ACT. Multivariable Cox analysis indicated that not achieving pathologic complete response (non-pCR) after NACT (versus ACT), was identified as an adverse prognostic factor for OS (HR 1.58, 95% CI 1.36-1.83) and BCSS (HR 1.70, 95% CI 1.44-2. 02). The logistic regression model revealed that low tumor grade independently predicted non-pCR.
CONCLUSIONS: Among T2N1M0 stage HR + /HER2- patients, OS and BCSS of NACT were inferior to ACT. Patients who attained non-pCR after NACT demonstrated significantly worse survival outcomes compared with those who received ACT.