Evaluating the Effectiveness of Neoadjuvant Chemotherapy in Reducing Mastectomy for Women With Breast Cancer

JNCI Cancer Spectrum

Lund, Jennifer L.¹  Mohiuddin, Jahan J.¹  Carey, Lisa A.¹  Baker, Brock R.¹  Marks, Lawrence B.¹  Chen, Ronald C.¹  Deal, Allison M.¹  Jones, Ellen L.¹  Zagar, Timothy M.¹ 

[1] Affiliations of authors: School of Medicine (JJM, BRB), Lineberger Comprehensive Cancer Center (AMD, JLL, LAC, TMZ, ELJ, LBM, RCC), Biostatistics Core Facility (AMD), Department of Epidemiology, Gillings School of Global Public Health (JLL), Division of Hematology-Oncology (LAC), Department of Radiation Oncology (TMZ, ELJ, LBM, RCC), Sheps Center for Health Services Research (RCC), University of North Carolina at Chapel Hill, Chapel Hill, NC.

关键词: mastectomy;    breast cancer;    cancer;    receptor, erbb-2;   

DOI  :  10.1093/jncics/pkx004

学科分类：肿瘤学

来源: Oxford University Press

【 摘 要 】

BackgroundNeoadjuvant chemotherapy in breast cancer reduced mastectomy rates by 7% to 13% in randomized trials. However, the differential effects for women with different stages, receptor subtypes, and ages are unknown. We compared mastectomy rates in women who did vs did not receive neoadjuvant chemotherapy in 18 patient subgroups. The main objective was to quantify the potential benefit from neoadjuvant chemotherapy in reducing mastectomy rates for each subgroup.MethodsOur retrospective analysis used data from the National Cancer Data Base, which includes approximately 70% of incident cancers across the United States. Absolute risk reductions for mastectomy were determined for 18 subgroups of clinical stage, receptor subtype, and age group. In each subgroup, propensity score weighting balanced measured covariates between women treated with vs without neoadjuvant chemotherapy.ResultsA total of 55 709 patients were analyzed. In clinical stage IIA disease, only patients with human epidermal growth factor receptor 2 (HER2)–positive tumors had reduced mastectomy rates associated with neoadjuvant chemotherapy (age < 60 years, 12%; age ≥ 60 years, 12.6%). For stage IIB cancers, neoadjuvant chemotherapy was associated with an absolute reduction in mastectomy rates of 5.9% in women younger than age 60 years with hormone receptor–positive/HER2- disease, 8.2% to 10.7% for triple-negative disease, and 11.7% to 17.4% for HER2+ disease. For stage IIIA, the reductions in mastectomy rates ranged from 6.6% to 15.9%.ConclusionsIn an analysis of patients treated across the United States, we found that neoadjuvant chemotherapy was associated with a reduction in mastectomy rates to a similar magnitude overall as shown in randomized trials, but this benefit varied widely by patient subgroup. This study provides novel information to help women make informed decisions regarding treatment.

【 授权许可】

CC BY-NC-ND