目标:在乳腺癌中,新辅助化疗(NAC)可以降低淋巴结状态,甚至可以导致病理性的完全反应,这与改善预后有关。本研究旨在确定NAC前后淋巴结状态的预后效果。
方法:如果在2005年至2019年之间确诊,则从荷兰癌症注册中心选择接受NAC治疗的乳腺癌女性,并根据NAC前的淋巴结状态进行分类:淋巴结阴性(cN0),或基于细针穿刺细胞学检查或芯针活检(cN)的淋巴结阳性。亚组基于NAC后的淋巴结状态:淋巴结疾病的不存在(ypN0)或存在(ypN)。通过Kaplan-Meier生存分析评估5年总生存率(OS),也按乳腺癌分子亚型。为了适应潜在的混杂因素,进行了多变量分析。
结果:共6,580例患者纳入cN0组,和11,878在cN+组中。cN0ypN0亚组的5年OS优于cN+ypN0亚组(94.4%对90.1%,p<0.0001)。在cN0以及cN+疾病中,与ypN0相比,ypN+的5年OS在统计学上显着较差。对于激素受体(HR)+人表皮生长因子受体2(HER2)-,HR+HER2+,HR-HER2+,和三阴性疾病,分别,cN0ypN+亚组的5年OS为89.7%,90.4%,73.7%,53.6%,在cN+ypN+-亚组84.7%,83.2%,61.4%,和48.8%。在多变量分析中,cN+和ypN+疾病均与OS恶化相关。
结论:这项研究表明,cN状态和ypN状态,和分子亚型应考虑进一步提高预后。
OBJECTIVE: In breast cancer, neoadjuvant chemotherapy (NAC) can downstage the nodal status, and can even result in a pathological complete response, which is associated with improved prognosis. This study aimed to determine the prognostic effect of nodal status before and after NAC.
METHODS: Women with breast cancer treated with NAC were selected from the Netherlands Cancer Registry if diagnosed between 2005 and 2019, and classified based on nodal status before NAC: node-negative (cN0), or node-positive based on fine needle aspiration cytology or core needle biopsy (cN+). Subgroups were based on nodal status after NAC: absence (ypN0) or presence (ypN+) of nodal disease. Five-year overall survival (OS) was assessed with Kaplan-Meier survival analyses, also per breast cancer molecular subtype. To adjust for potential confounders, multivariable analyses were performed.
RESULTS: A total of 6,580 patients were included in the cN0 group, and 11,878 in the cN+ group. The 5-year OS of the cN0ypN0-subgroup was statistically significant better than that of the cN+ypN0-subgroup (94.4% versus 90.1%, p < 0.0001). In cN0 as well as cN+ disease, ypN+ had a statistically significant worse 5-year OS compared to ypN0. For hormone receptor (HR)+ human epidermal growth factor receptor 2 (HER2)-, HR+ HER2+, HR-HER2+, and triple negative disease, respectively, 5-year OS in the cN0ypN+-subgroup was 89.7%, 90.4%, 73.7%, and 53.6%, and in the cN+ypN+-subgroup 84.7%, 83.2%, 61.4%, and 48.8%. In multivariable analyses, cN+ and ypN+ disease were both associated with worse OS.
CONCLUSIONS: This study suggests that both cN-status and ypN-status, and molecular subtype should be considered to further improve prognostication.