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首页> 外文期刊>Journal of Clinical Oncology >Factors predictive of distant metastases in patients with breast cancer who have a pathologic complete response after neoadjuvant chemotherapy.
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Factors predictive of distant metastases in patients with breast cancer who have a pathologic complete response after neoadjuvant chemotherapy.

机译:新辅助化疗后病理完全缓解的乳腺癌患者远处转移的预测因素。

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摘要

PURPOSE: To identify clinicopathological factors predictive of distant metastasis in patients who had a pathologic complete response (pCR) after neoadjuvant chemotherapy (NC). METHODS: Retrospective review of 226 patients at our institution identified as having a pCR was performed. Clinical stage at diagnosis was I (2%), II (36%), IIIA (27%), IIIB (23%), and IIIC (12%). Eleven percent of all patients were inflammatory breast cancers (IBC). Ninety-five percent received anthracycline-based chemotherapy; 42% also received taxane-based therapy. The relationship of distant metastasis with clinicopathologic factors was evaluated, and Cox regression analysis was performed to identify independent predictors of development of distant metastasis. RESULTS: Median follow-up was 63 months. There were 31 distant metastases. Ten-year distant metastasis-free rate was 82%. Multivariate Cox regression analysis using combined stage revealed that clinical stages IIIB, IIIC, and IBC (hazard ratio [HR], 4.24; 95% CI, 1.96 to 9.18; P < .0001), identification of < or = 10 lymph nodes (HR, 2.94; 95% CI, 1.40 to 6.15; P = .004), and premenopausal status (HR, 3.08; 95% CI, 1.25 to 7.59; P = .015) predicted for distant metastasis. Freedom from distant metastasis at 10 years was 97% for no factors, 88% for one factor, 77% for two factors, and 31% for three factors (P < .0001). CONCLUSION: A small percentage of breast cancer patients with pCR experience recurrence. We identified factors that independently predicted for distant metastasis development. Our data suggest that premenopausal patients with advanced local disease and suboptimal axillary node evaluation may be candidates for clinical trials to determine whether more aggressive or investigational adjuvant therapy will be of benefit.
机译:目的:确定在新辅助化疗(NC)后发生病理完全缓解(pCR)的患者中预测远处转移的临床病理因素。方法:对我院226例经鉴定为pCR的患者进行回顾性研究。诊断时的临床分期为I(2%),II(36%),IIIA(27%),IIIB(23%)和IIIC(12%)。在所有患者中,有11%是发炎性乳腺癌(IBC)。 95%的患者接受基于蒽环类的化疗; 42%的人也接受了紫杉烷类疗法。评估远处转移与临床病理因素之间的关系,并进行Cox回归分析,以确定远处转移发展的独立预测因子。结果:中位随访时间为63个月。有31处远处转移。十年远处无转移率为82%。使用合并分期的多变量Cox回归分析显示,临床分期为IIIB,IIIC和IBC(危险比[HR]为4.24; 95%CI为1.96至9.18; P <.0001),识别出≤10个淋巴结(HR ,2.94; 95%CI,1.40至6.15; P = .004)和绝经前状态(HR,3.08; 95%CI,1.25至7.59; P = .015)预测远处转移。 10年无远处转移的无因素率为97%,单因素为88%,两因素为77%,三因素为31%(P <.0001)。结论:一小部分患有pCR的乳腺癌患者会复发。我们确定了独立预测远处转移发展的因素。我们的数据表明,患有晚期局部疾病且腋窝结节评估不佳的绝经前患者可能是临床试验的候选人,以确定更积极或研究性的辅助治疗是否有益。

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