Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy

PURPOSE: The aim of this study was to investigate the role of postmastectomy radiation therapy in women with breast cancer who achieved a pathologic complete response (pCR) to neoadjuvant chemotherapy. METHODS AND MATERIALS: We retrospectively identified 226 patients treated at our institution who achieved a pCR at surgery after receiving neoadjuvant chemotherapy. Of these, the 106 patients without inflammatory breast cancer who were treated with mastectomy were analyzed. The patients' clinical stages at diagnosis were I in 2%, II in 31%, IIIA in 30%, IIIB in 25%, and IIIC in 11% (American Joint Committee on Cancer 2003 system). Of the patients, 92% received anthracycline-based chemotherapy, and 38% also received a taxane. A total of 72 patients received postmastectomy radiation therapy, and 34 did not. The actuarial rates of local-regional recurrence (LRR) and survival of the two groups were compared using the log-rank test. RESULTS: The median follow-up of surviving patients was 62 months. Use of radiation therapy did not affect the 10-year rates of LRR for patients with Stage I or II disease (the 10-year LRR rates were 0% for both groups). However, the 10-year LRR rate for patients with Stage III disease was significantly improved with radiation therapy (7.3% +/- 3.5% with vs. 33.3% +/- 15.7% without; p = 0.040). Within this cohort, use of radiation therapy was also associated with improved disease-specific and overall survival. CONCLUSION: Postmastectomy radiation therapy provides a significant clinical benefit for breast cancer patients who present with clinical Stage III disease and achieve a pCR after neoadjuvant chemotherapy.     

局部晚期直肠癌新辅助治疗pCR相关因素研究

目的 评价局部晚期直肠癌新辅助治疗后pCR的相关影响因素。方法 回顾分析2011—2013年间收治的265例AJCC分期Ⅱ、Ⅲ期直肠癌患者资料。所有患者均接受新辅助治疗±等待手术间期化疗, 而后手术。运用单因素和二元Logistic回归多因素分析影响pCR的预测因素, 并根据预测危险因素进行归类后分为无风险组(无因素)、低风险组(1个因素)、高风险组(2个因素)。建立临床风险评估模型。因素分析运用二元Logistic回归模型。结果 达pCR者50例(18.9%)。单因素分析中新辅助治疗前CEA、放化疗前T分期、同期放化疗结束至手术间隔时间和放化疗前肿瘤最大厚度对pCR有影响(P=0.017、0.001、0.000、0.040), 多因素分析显示新辅助治疗前CEA水平和同期放化疗结束至手术间隔时间是pCR影响因素(P=0.021、0.001), 进一步分层分析表明只有非吸烟组中新辅助治疗前低水平CEA对pCR有影响(P=0.044)。临床风险评估模型诊断pCR的敏感性为80.5%, 特异性为46.0%, AUC为0.690, 阳性预测值为35.49%, 阴性预测值为86.5%, 准确性为73.9%。结论 新辅助治疗能使部分局部晚期直肠癌患者达pCR。新辅助治疗前低水平CEA和更长的同期放化疗结束至手术间隔时间是局部晚期直肠癌新辅助治疗pCR的预测因素, 而新辅助治疗前低水平CEA对pCR预测只在非吸烟人群中有效。根据新辅助治疗前CEA>5 ng/ml和同期放化疗结束至手术间隔时间≤8周的危险因素建立的临床风险评估模型可用于预测局部晚期直肠癌新辅助治疗pCR率。     

进展期胃癌新辅助治疗后病理完全缓解相关因素分析及风险预测模型建立

目的:探讨局部进展期胃癌新辅助治疗后病理完全缓解(pathological complete response,pCR)的临床相关因素。方法:回顾性分析2011年6月至2018年3月河北医科大学第四医院收治的452例局部进展期胃癌患者cT3～4N+～M0新辅助治疗及手术的临床资料,采用单因素分析及Logistic多因素回归分析法研究pCR的临床相关因素。结果:452例患者全部完成新辅助治疗及根治性手术,其中44例(9.7%)患者达到pCR。治疗前T分期为T3期、肿瘤最长径<4 cm、治疗前CA199≤30 U/mL、治疗结束与手术时间间隔≥6周、同步放化疗或联合靶向治疗方案与进展期胃癌新辅助治疗后高pCR率有关(均P<0.05)。治疗前T分期为T3期、CA199≤30 U/mL、肿瘤最长径<4 cm、新辅助同步放化疗或联合靶向治疗是影响进展期胃癌新辅助治疗后出现pCR的独立因素(均P<0.05)。以上每项指标出现pCR的预测评分均为1分。评分>2分患者出现pCR的概率为34.48%,评分≤2分患者出现pCR的概率为6.09%。结论:治疗前临床分期、CA19...     

局部进展期直肠癌新辅助化疗后病理完全缓解及肿瘤降期的预测因素分析

目的:探索局部进展期直肠癌(LARC)经新辅助化疗后病理完全缓解(pCR)和肿瘤降期(ypT0-1)的预测因素.方法:回顾性分析71例经新辅助化疗后进行全直肠系膜切除术的局部进展期直肠癌患者的临床资料,分析其临床特征,筛选经新辅助化疗后达到pCR及肿瘤降期(ypT0-1)的预测因子.结果:单因素分析结果显示肿瘤占肠腔<...     

乳腺癌患者新辅助化疗后病理完全缓解的相关影响因素分析及列线图预测模型的构建

目的:建立关于乳腺癌新辅助化疗后病理完全缓解的综合预测模型,预测新辅助化疗后病理缓解,指导临床上诊疗方案的选择。方法:回顾分析2015年1月至2020年3月148例乳腺癌新辅助化疗患者的临床资料、化疗前核磁共振资料及病理资料,根据术后病理分为pCR组与npCR组。采用χ2检验对两组指标先行单因素分析;将P＜0.05的指标及考虑可能有临床意义的指标纳入多因素Logistic回归分析。应用多因素分析考虑有统计学意义(P＜0.05)及临床意义的指标构建乳腺癌新辅助化疗后病理缓解综合预测模型的列线图,并运用ROC曲线评价此模型的效能。结果:单因素分析表明腺体背景强化类型、最长径、病理分型对乳腺癌是否达到病理完全缓解具有预测作用;多因素分析表明,腺体背景强化类型、最长径、病理分型均是新辅助化疗后病理完全缓解的独立预测因素(P＜0.05)。乳腺癌新辅助化疗后病理缓解的预测模型的曲线下面积为0.769,特异度为65.5%,敏感度为78.9%。结论:乳腺癌新辅助化疗后病理完全缓解的综合预测模型对病理缓解状态有较好的预测能力,此模型可为乳腺癌新辅助化疗后患者选择手术方式提供参考。     

局部晚期直肠癌术前同期放化疗达pCR者预后分析

目的 分析与局部晚期直肠癌患者术前放化疗后达pCR相关的临床因素。方法 搜集2005—2012年间经活检证实并neo-CRT (放疗采用3DCRT、VMAT)及根治性切除的临床资料完整的局部晚期直肠癌297例,采用Logistic回归模型多因素分析年龄、性别、肿瘤距肛门距离、疗前血清CEA水平、疗前血红蛋白、cT分期、cN分期与pCR是否相关。结果 全组疗后达pCR者78例(26.7%),T₁—T₃期者达42例(34.4%),T₄期者达37例(21.1%)。疗前CEA≤5.33 ng/ml疗后达pCR者55例(36.4%),CEA>5.33 ng/ml仅24例(16.4%)。单因素分析年龄、性别、肿瘤距肛门距离、疗前是否贫血和cN分期与pCR无关。多因素分析cT₁—T₃期、疗前CEA≤5.33 ng/ml是影响局部晚期直肠癌neo-CRT后是否达pCR的影响因素(P=0.031、0.000)。结论 临床分期、疗前血清CEA水平是影响局部晚期直肠癌neo-CRT后是否达pCR的影响因素;疗前血清CEA水平可作为局部晚期直肠癌neo-CRT后是否达pCR的筛选指标之一。     

直肠腺癌新辅助放化疗疗效影响因素及病理完全缓解对预后的影响

  目的  探讨直肠腺癌新辅助放化疗（neoadjuvant chemoradiotherapy,NCRT）后病理完全缓解（pathologic complete response,pCR）的影响因素及pCR对生存的影响。  方法  回顾性分析2014年1月至2017年12月郑州大学附属肿瘤医院收治的98例直肠腺癌NCRT患者的临床病理资料,分析临床病理特征与pCR的关系以及pCR对预后的影响。  结果  98例患者NCRT后19例（19.4%）获得pCR。单因素分析显示,术前淋巴结转移情况、治疗前CEA水平、肿瘤大小、肿瘤侵犯肠壁周径程度以及KRAS基因状态与直肠腺癌NCRT后pCR相关。Logistic回归多因素分析显示,治疗前CEA≤5 μg/L（OR=4.095,95%CI:1.131~14.823,P=0.032）和肿瘤侵犯肠壁周径（≤1/2）（OR=3.268,95%CI:1.015~10.527,P=0.047）是影响直肠腺癌NCRT后pCR的独立因素。生存分析显示非pCR患者的3年无病生存率（disease-free survival,DFS）为71.1%,显著低于pCR患者100%（P < 0.05）;两者3年总生存率（overall survival,OS）分别为100%和88.5%,差异无统计学意义（P>0.05）。  结论  治疗前检测CEA以及评估肿瘤侵犯肠壁周径程度有助于预测直肠腺癌NCRT后pCR率,提示两者可作为新辅助放化疗疗效的评价指标,并指导临床进行个体化治疗。与pCR患者相比,非pCR直肠癌患者DFS较短。      

直肠癌术前放化疗完全缓解后的临床策略分析

  目的  探讨直肠癌经新辅助放化疗后获得完全缓解病例的处理办法。  方法  回顾性分析河南大学淮河医院2010年1月至2014年8月收治的直肠癌术前进行新辅助放化疗的84例患者临床资料。  结果  经过新辅助放化疗,33例（39.3%）患者获得临完全床缓解（clinical complete response,cCR）;经术后病理检查,6例患者获得病理完全缓解（pathological complete response,pCR）,占cCR病例的18.2%（6/33）,术后随访12~36个月均未出现肿瘤转移复发情况。  结论  新辅助放化疗能明显降低肿瘤分期,并能使部分患者获得cCR。对于cCR病例,不建议非手术治疗。      

Improved survival with adjuvant chemotherapy in locally advanced rectal cancer patients treated with preoperative chemoradiation regardless of pathologic response

ObjectiveThe aim of this study is to examine the effect of postoperative chemotherapy on survival in patients with stage II or III rectal adenocarcinoma who undergo neoadjuvant chemoradiation (CRT) and surgical resection.MethodsA retrospective review of the National Cancer Database (NCDB) from 2006 to 2013 was performed. Cases were analyzed based on pathologic complete response (pCR) status and use of adjuvant therapy. The Kaplan-Meier method was used to estimate overall survival probabilities.Results23,045 cases were identified, of which 5832 (25.31%) achieved pCR. In the pCR group, 1513 (25.9%) received adjuvant chemotherapy, and in the non-pCR group, 5966 (34.7%) received adjuvant therapy. In the pCR group, five-year survival probability was 87% (95% CI 84%–89%) with adjuvant therapy and 81% (95% CI 79%–82%) without adjuvant therapy. In the non-pCR group, five-year survival probability was 78% (95% CI 76%–79%) with adjuvant therapy and 70% (95% CI 69%–71%) without adjuvant therapy. In the non-pCR and node-negative subgroup (ypN-), five-year survival probability was 86% (95% CI 84%–88%) with adjuvant therapy and 76% (95% CI 74%–77%) without adjuvant therapy. In the non-pCR and node-positive subgroup (ypN+), five-year survival probability was 67% (95% CI 65%–70%) with adjuvant therapy and 60% (95% CI 58%–63%) without adjuvant therapy.ConclusionsAdjuvant chemotherapy in stage II or III rectal adenocarcinoma is associated with increased five-year survival probability regardless of pCR status. We observed similar survival outcomes among non-pCR ypN- treated with adjuvant chemotherapy compared with patients achieving pCR treated with adjuvant chemotherapy.     

Breast radiologic complete response is associated with favorable survival outcomes after neoadjuvant chemotherapy in breast cancer

BackgroundThe aim of this study was to examine the accuracy of radiologic complete response (rCR) in predicting pathologic complete response (pCR), and determine whether rCR is a predictor of favorable survival outcomes.Materials and methodsWe retrospectively reviewed breast cancer patients treated with neoadjuvant chemotherapy (NAC) followed by surgery from September 2007 to June 2016. Breast lesions and axillary nodes were measured by MRI and categorized into either disappeared (breast rCR) or residual disease (breast non-rCR) and either normalized (axillary rCR) or abnormal findings (axillary non-rCR) in the axillary nodes. Correlation between rCR and pCR were compared using Cohen’s Kappa statistics, and the recurrence-free survival (RFS) and overall survival (OS) rates were calculated by the Kaplan-Meier method.ResultsOut of the 1017 eligible patients, 287 (28.2%) achieved breast pCR, 165 (16.2%) achieved breast rCR, 529 (52.0%) had axillary pCR, and 274 (26.9%) achieved axillary rCR. The correlation between a breast rCR and pCR showed a Cohen’s Kappa value of 0.459, and between axillary rCR and pCR, the value was 0.384. During a median follow-up time of 48.0 months, the 5-year RFS rates were 90.6% for breast rCR, and 69.2% for breast non-rCR. The 5-year RFS rates were 82.3% for axillary rCR, and 68.8% for axillary non-rCR. Patients without breast rCR had a 2.4-fold significant increase in the risk of recurrence (p = 0.004) compared to patients with breast rCR.ConclusionAlthough rCR correlated with pCR by only moderate to fair degrees, breast rCR was a strong predictor for a favorable RFS outcome.     

Axillary lymph node status,adjusted for pathologic complete response in breast and axilla after neoadjuvant chemotherapy,predicts differential disease-free survival in breast cancer

Background

Our retrospective study in breast cancer patients evaluated whether integrating subtype and pathologic complete response (pcr) information into axillary lymph node restaging after neoadjuvant chemotherapy (nac) adds significance to its prognostic values.

Methods

Patients included in the analysis had stage ii or iii disease, with post-nac axillary lymph node dissection (alnd), without sentinel lymph node biopsy before completion of nac, with definitive subtyping data and subtype-oriented adjuvant treatments. The ypN grading system was used to restage axillary lymph node status, and ypN0 was adjusted by pcr in both breast and axilla into ypN0(pcr) and ypN0(non-pcr). Univariate and multivariate survival analyses were performed.

Results

Among the 301 patients analyzed, 145 had tumours that were hormone receptor–positive (hr+) and negative for the human epidermal growth factor receptor (her2–), 101 had tumours that were positive for her2 (her2+), and 55 had tumours that were triple-negative. The rate of pcr in both breast and axilla was 11.7%, 43.6%, and 25.5% respectively for the 3 subtypes. Compared with the non-pcr patients, the pcr patients had better disease-free survival (dfs) and overall survival (os): p = 0.002 for dfs and p = 0.011 for os. In non-pcr patients, dfs and os were similar in the ypN0(non-pcr) and ypN1 subgroups, and in the ypN2 and ypN3 subgroups. We therefore grouped the ypN grading results into ypN0(pcr) (n = 75), ypN0– 1(non-pcr) (n = 175), and ypN2–3 (n = 51). In those groups, the 3-year dfs was 98%, 91%, and 56%, and the 3-year os was 100%, 91%, and 82% respectively. The differences in dfs and os between those three subgroups were significant (all p < 0.05 in paired comparisons). Multivariate Cox regression showed that subtype and ypN staging adjusted by pcr were the only two independent factors predicting dfs.

Conclusions

Axillary lymph node status after nac, adjusted for pcr in breast and axilla, predicts differential dfs in patients without prior sentinel lymph node biopsy.