在新辅助疗法后,乳腺癌的辅助化疗:必要还是可选?
Di Zhang1, Luo Yang2, Yuan Zheng1
1Qilu Hospital of Shandong University, Jinan, Shandong, China.
Cancer research and treatment
|April 30, 2025
概括
术后辅助化疗 (AC) 改善了新辅助化疗 (NAC) 和手术后高风险乳腺癌 (BC) 患者的生存率. 低风险患者没有受益,这表明AC可以安全地被遗漏.
科学领域:
- 在瘤学瘤学.
- 临床研究 临床研究
- 癌症治疗方法 癌症治疗方法
背景情况:
- 术后的新辅助化疗 (NAC) 是乳腺癌 (BC) 的标准治疗方法.
- 随后的术后辅助化疗 (AC) 在改善这些患者的生存结果方面的作用仍然是研究领域.
- 个性化治疗策略对于优化疗效和最小化毒性至关重要.
研究的目的:
- 评估术后辅助化疗 (AC) 对乳腺癌 (BC) 患者的生存结果的影响,这些患者先前接受过新辅助化疗 (NAC) 和手术治疗.
- 在这个患者群体中确定影响整体生存 (OS) 的预后因素.
- 开发和验证风险分层和个性化AC决策的预测模型.
主要方法:
- 对15,921名BC患者 (2010-2020年) 的基于人口的队列进行分析,分为培训 (11,144) 和验证 (4,777) 组.
- 使用单变量和多变量考克斯回归来确定总生存时间 (OS) 的显著预后指标.
- 开发并验证了个性化风险评估和患者分层的诺米克图,以确定AC的益处.
主要成果:
- 关键的预后因素包括年龄,种族,婚姻状况,组织学等级,BC亚型,T阶段,N阶段,手术类型和NAC反应 (所有p<0.05).
- 诺米图准确地预测了OS,并将患者分为不同的风险类别.
- 在高风险小组 (p=0.011培训,p=0.012整体) 中,术后AC显著改善了OS,但在低风险小组 (p=0.130培训,p=0.588整体) 中没有.
结论:
- 开发的诺米图有效地根据整体生存风险对乳腺癌患者进行分层.
- 高风险患者从术后AC中受益,而低风险患者没有显著的生存优势.
- 这种风险分层允许个性化治疗决策,可能使得在选择的患者中忽略不必要的术后AC,以减少过度治疗.
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