Survival outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer patients.

IF 4.2 2区医学 Q1 ONCOLOGY

Oncologist Pub Date : 2025-10-22 DOI:10.1093/oncolo/oyaf356

Chengshi Wang, Jianhui Zhang, Juecai Chen, Xiaoyan Zhang, Songbo Zhang, Purong Zhang, Junjie Li

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引用次数: 0

Abstract

Background: Neoadjuvant chemotherapy (NACT) has been widely used in breast cancer patients. The aim of the study was to compare survival outcomes between breast cancer patients receiving NACT, with and without complete pathologic response (pCR), and those receiving adjuvant chemotherapy (ACT).

Methods: Based on the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 48,350 breast cancer patients, 15,525 of whom with pCR after NACT, and 124,202 patients after ACT during the period of 2010-2021. In comparison with patients in ACT group, we assessed hazard ratios (HRs) of breast cancer-specific and overall mortality among individuals in NACT using Cox regression.

Results: During the period of follow-up (median 5 years), 4,800 and 8,257 breast cancer-related deaths were identified among patients in NACT and ACT group, respectively. Patients in NACT group had unfavorable molecular type (human epidermal growth factor receptor 2 overexpression, triple negative), more advanced tumor features (higher grade and stage) and was more likely to undergo mastectomy and radiotherapy. Moreover, patients undergoing NACT had higher cumulative mortality rate of breast cancer (19.60% vs 10.46%), compared with those receiving ACT. After controlling for covariates, NACT patients were at increased risk of breast cancer-specific mortality (HR 1.47, 95% CI 1.41-1.53) compared with ACT patients. In contrast, NACT patients with pCR were associated with an improved breast cancer-specific survival (HR 0.59, 95% CI 0.54-0.64). The elevated risk was obviously greater among NACT patients in NACT-disfavored subgroups including lobular/mixed histology, well/moderately differentiated grade, local cancer stage, or HR+/HER2- molecular subtype (HRs 1.63-1.93).

Conclusions: NACT patients have worse survival, compared with their ACT counterparts. Although patients with pCR after NACT derive significant survival benefits, NACT-disfavored subgroups may gain limited benefit from NACT, and alternative approaches should be considered.

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早期乳腺癌患者新辅助化疗与辅助化疗的生存结局。

背景：新辅助化疗（NACT）已广泛应用于乳腺癌患者。该研究的目的是比较接受NACT的乳腺癌患者，有和没有完全病理反应（pCR）和接受辅助化疗（ACT）的患者的生存结果。方法：基于监测、流行病学和最终结果数据库，我们开展了一项基于人群的队列研究，包括48,350例乳腺癌患者，其中15,525例患者在NACT后进行了pCR， 124,202例患者在ACT后进行了pCR。与ACT组患者相比，我们使用Cox回归评估了NACT组患者乳腺癌特异性死亡率和总死亡率的风险比（hr）。结果：在随访期间（中位5年），NACT组和ACT组分别有4800例和8257例乳腺癌相关死亡。NACT组患者分子类型不利（人表皮生长因子受体2过表达，三阴性），肿瘤特征更晚期（分级和分期更高），更有可能接受乳房切除术和放疗。此外，与接受ACT的患者相比，接受NACT的患者的乳腺癌累积死亡率更高（19.60% vs 10.46%）。在控制了协变量后，与ACT患者相比，NACT患者的乳腺癌特异性死亡率风险增加（HR 1.47, 95% CI 1.41-1.53）。相比之下，采用pCR的NACT患者与乳腺癌特异性生存率的提高相关（HR 0.59, 95% CI 0.54-0.64）。在NACT不受欢迎的亚组中，包括小叶/混合组织学、良好/中度分化分级、局部癌症分期或HR+/HER2-分子亚型，NACT患者的风险升高明显更大（HR = 1.63-1.93）。结论：与ACT患者相比，NACT患者的生存率更差。尽管在NACT后进行pCR的患者获得了显著的生存益处，但NACT不受欢迎的亚组可能从NACT中获得有限的益处，应考虑其他方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncologist 医学-肿瘤学

CiteScore

10.40

自引率

3.40%

发文量

309

审稿时长

3-8 weeks

期刊介绍： The Oncologist® is dedicated to translating the latest research developments into the best multidimensional care for cancer patients. Thus, The Oncologist is committed to helping physicians excel in this ever-expanding environment through the publication of timely reviews, original studies, and commentaries on important developments. We believe that the practice of oncology requires both an understanding of a range of disciplines encompassing basic science related to cancer, translational research, and clinical practice, but also the socioeconomic and psychosocial factors that determine access to care and quality of life and function following cancer treatment.