Long-term Outcomes and Predictors for response of Breast Cancer following Neoadjuvant Chemotherapy

Autor: Dong-Hua Wang, 王董華
Rok vydání: 2019
Druh dokumentu: 學位論文 ; thesis
Popis: 107
Objective：According to the 2018 Taiwan Cancer Registry Report, female breast cancer was the commonest cancer and the fourth leading cause of death for women with malignancies. Nowadays neoadjuvant chemotherapy is widely used to treat locally advanced breast cancer (Stage II~III). It can reduce the tumor size to facilitate breast conservative surgery for patients with large breast tumor. Pathological complete remission（pCR）after neoadjuvant chemotherapy is an important prognostic factor regarding overall survival and disease free survival. The purpose of this study is to figure out the predictive factors of pCR and find out the candidate of neoadjuvant chemotherapy. Methods：The data is from the Cancer Registry database of a tertiary center in southern Taiwan medical center between 2010 and 2016. The enrollment criteria include stage II or stage III breast cancer, female patient, and complete treatment. The latter includes surgery and chemotherapy planned. Male patients and those with missing data are excluded. Those with histological subtypes not feasible for AJCC 7th stage are not included in this study, either. The propensity score matching method is used for comparing the effect of neoadjuvant chemotherapy. With logistic regression analysis, tumor size、ER、PR、HER-2、clinical T、clinical lymph metastasis and grade are selected as the covariate for balancing the baseline characteristics of the two groups. To compare overall survival and disease-free survival, Kaplan-Meier method and log-rank are used. The difference of pCR rate was tested by Chi-square test. Result：Total 458 patients met the study entrance criteria. Among them, sixty eight（14.85%）patients received neoadjuvant chemotherapy and surgery and seven patients achieved pCR. After propensity score matching, both neoadjuvant chemotherapy and upfront surgery arm have 62 patients. Between the two arms, no significant difference in the overall survival and disease-free survival. Regarding the potential impact or interaction between stage and neoadjuvant chemotherapy, statistically significant differences in overall survival (p = 0.007) and disease-free survival (p = 0.002) is noted after stratification with stage and neoadjuvant chemotherapy. For stage II breast cancer patients, those receiving upfront surgery have better overall survival than those with neoadjuvant chemotherapy. However, patients would have better overall survival with neoadjuvant chemotherapy if they are diagnosed with stage III disease. There was no statistically significant difference in the overall survival (p=0.995) and disease-free survival (p=0.459) between pCR and non-pCR patients. Regarding the interval between neoadjuvant chemotherapy and surgery, the five year overall survival and disease-free survival for those with the interval not longer than 4 weeks were 90.0% and 80.8%, respectively. The 5-year overall survival and disease-free survival were 70.7% and 58.1% for patients with the interval longer than 4 weeks. The difference between OS and DFS were not statistically significant (both p =0.280). Conclusion：Our study showed the overall survival is higher for stage II patients without neoadjuvant chemotherapy than those with neoadjuvant chemotherapy. It is suggested that stage II breast cancer patients with either hormonal receptor positive or low grade tumor may be beneficial of upfront surgery. However, the administration of neoadjuvant chemotherapy makes stage III patients overall survival better. Thus, the patients with stage III disease should consider neoadjuvant chemotherapy first. Although not reaching statistical significance, there is a trend that the interval between neoadjuvant chemotherapy and surgery more than 4 weeks is associated with worse survival. Therefore, the surgery should be done within 4 weeks after neoadjuvant chemotherapy is recommended.
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