巴西多中心队列的乳腺癌新辅助化疗的真实世界证据：病理完全缓解与总生存期的相关性。
Real-world evidence of neoadjuvant chemotherapy for breast cancer treatment in a Brazilian multicenter cohort: Correlation of pathological complete response with overall survival.
发表日期：2023 Sep 14
作者：
Marcelo Antonini, André Mattar, Fernanda Grace Bauk Richter, Gabriel Duque Pannain, Marina Diógenes Teixeira, Andressa Gonçalves Amorim, Odair Ferraro, Reginaldo Coelho Guedes Lopes, Luiz Henrique Gebrim, Juliana Monte Real
来源：
BREAST
摘要：
我们旨在评估巴西多中心队列中接受新辅助化疗（NAC）治疗乳腺癌（BC）患者pCR率。此外，我们旨在利用RWD评估pCR对OS和DFS的影响。这是一项回顾性的多中心队列研究，包括18岁以上的女性患者，她们被诊断为非转移性乳腺癌并接受NAC。使用Kaplan-Meier方法估计了5年内的OS和DFS。此外，我们进行了多变量分析，以确定与pCR和OS显著相关的因素。从2011年到2020年，共有1891名患者纳入研究，其中421名（22.3%）达到了pCR（ypT0 ypN0）。考虑到残余的DCIS，有467名患者（23.5%）达到了pCR。不同亚型的pCR率有所不同：HER-2+（p = 0.016）和临床III A和IIIB期（p < 0.001）。在HER-2+患者中，接受曲妥珠单抗治疗的患者pCR率明显高于未接受曲妥珠单抗治疗的患者（p < 0.0001）。同样，TNBC患者接受铂类方案治疗的患者也显示出更高的pCR率（p < 0.0001）。根据pCR状态对OS进行了分组，pCR组的OS率为88.3%，非pCR组的OS率为58.1%（p < 0.0001）。5年DFS在pCR组为92.2%，非pCR组为64.3%（p < 0.0001）。pCR率及其预后价值在BC亚型之间存在差异。在我们的研究中，pCR可作为有利的临床结果的代理，因为它与更高的OS和DFS率相关联。版权所有©2023作者。由Elsevier Ltd.发表。保留所有权利。
We aimed to evaluate the pCR rate in patients receiving NAC for the treatment of breast cancer (BC) in a multicenter cohort in Brazil. Additionally, we aimed to use RWD to assess the impact of pCR on OS and DFS.This was a retrospective, multicenter cohort study that included female patients over 18 years of age who were diagnosed with nonmetastatic breast cancer and received NAC. OS and DFS at five years were estimated by the Kaplan‒Meier method. Additionally, we conducted a multivariate analysis to identify factors that were significantly associated with pCR and OS.From 2011 to 2020, 1891 patients were included in the study, and 421 (22,3%) achieved pCR (ypT0 ypN0). Considering the presence of residual DCIS, pCR was achieved in 467 patients (23,5%). The pCR rate varied between the subtypes: HER-2+ (p = 0,016) and clinical stage IIIA and IIIB (p < 0,001). Among HER-2+ patients, those who received trastuzumab had a significantly higher pCR rate than those who did not receive trastuzumab (p < 0.0001). Similarly, patients with TNBC who received treatment with platinum-based regimens also showed higher pCR rates (p < 0.0001). OS was grouped according to pCR status, and the OS rate was 88,3% in the pCR group and 58.1% in the non-pCR group (p < 0.0001). The five-year DFS was 92.2% in the pCR group and 64.3% in the non-pCR group (p < 0.0001).The pCR rate and its prognostic value varied across BC subtypes. In our study, pCR could be used as a surrogate of favorable clinical outcome, as it was associated with higher OS and DFS rates.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.