乳腺癌新辅助化疗后改良根治术后放疗开始时间对预后的影响

目的 本研究旨在分析接受新辅助化疗的局部晚期乳腺癌患者改良根治手术时间到放疗开始时间(SRI)对患者预后的影响。方法 回顾性分析全国11家肿瘤中心的1087例接受新辅助化疗和改良根治术后放疗的乳腺癌患者。用Maxstat方法寻找手术到放疗间隔时间对预后影响的最佳界值。采用Cox多因素回归和倾向配比评分(PSM)分析手术距放疗间隔时间对预后的影响。结果 全组中位随访72.9个月,5年无瘤生存(DFS)率和总生存(OS)率分别为68.1%和81.8%。全组患者分为SRI≤18周(917例)和 SRI>18周(170例)两组。多因素分析显示激素受体状态、病理T分期、病理N分期和SRI是DFS影响因素(P<0.001、<0.001、<0.001、0.023)。激素受体状态、病理T分期、病理N分期、内分泌治疗和SRI是OS影响因素(P=0.013、0.006、<0.001、0.013、0.001)。采用PSM均衡两组患者临床病理因素后SRI≤18周患者DFS和OS仍然优于SRI>18周者。结论 新辅助化疗后乳腺癌患者改良根治手术到放疗间隔时间影响预后,患者应尽量在手术后18周内开始放疗。

Delay in initiating postmastectomy radiotherapy is associated with inferiorsurvival outcomes for locally advanced breast cancer patients treated with neoadjuvant chemotherapy and mastectomy

Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage cⅡ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy. Methods Clinical data of 1087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed. The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method. The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM). Results The median follow-up time was 72.9 months. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1% and 81.8%. All patients were divided into SRI≤18 weeks (n=917) and SRI>18 weeks groups (n=170). Multivariate Cox regression analysis demonstrated that hormone receptor status (P<0.001), pathological T stage (P<0.001), pathological N stage (P<0.001) and SRI (P=0.023) were independent influencing factors of DFS. Hormone receptor status (P=0.013), pathological T stage (P=0.006), pathological N stage (P<0.001), endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS. After balancing the clinical and pathological factors with PSM, patients with SRI< 18 weeks had superior DFS and OS to those with SRI> 18 weeks. Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy. Radiotherapy should be performed within 18 weeks after mastectomy.