Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials

被引：1021

作者：

Alberro, J. A. ^{[1
]}

Ballester, B. ^{[1
]}

Deulofeu, P. ^{[1
]}

Fabregas, R. ^{[1
]}

Fraile, M. ^{[1
]}

Gubern, J. M. ^{[1
]}

Janer, J. ^{[1
]}

Moral, A. ^{[1
]}

de Pablo, J. L. ^{[1
]}

Penalva, G. ^{[1
]}

Puig, P. ^{[1
]}

Ramos, M. ^{[1
]}

Rojo, R. ^{[1
]}

Santesteban, P. ^{[1
]}

Serra, C. ^{[1
]}

Sola, M. ^{[1
]}

Solarnau, L. ^{[1
]}

Solsona, J. ^{[1
]}

Veloso, E. ^{[1
]}

Vidal, S. ^{[1
]}

Abe, O. ^{[2
,106
]}

Abe, R. ^{[2
]}

Enomoto, K. ^{[2
]}

Kikuchi, K. ^{[2
,106
]}

Koyama, H. ^{[2
]}

Masuda, H. ^{[2
]}

Nomura, Y. ^{[2
]}

Ohashi, Y. ^{[2
]}

Sakai, K. ^{[2
]}

Sugimachi, K. ^{[2
]}

Toi, M. ^{[2
]}

Tominaga, T. ^{[2
]}

Uchino, J. ^{[2
]}

Yoshida, M. ^{[2
]}

Coles, C. E. ^{[3
]}

Haybittle, J. L. ^{[3
]}

Moebus, V. ^{[4
]}

Leonard, C. F. ^{[5
]}

Calais, G. ^{[6
]}

Garaud, P. ^{[6
]}

Collett, V. ^{[7
]}

Davies, C. ^{[7
]}

Delmestri, A. ^{[7
]}

Sayer, J. ^{[7
]}

Harvey, V. J. ^{[8
]}

Holdaway, I. M. ^{[8
]}

Kay, R. G. ^{[8
]}

Mason, B. H. ^{[8
]}

Forbe, J. F. ^{[9
]}

Franci, P. A. ^{[9
]}

机构：

[1] AARTM 048 13 2000 Multictr Study Grp, Madrid, Spain

[2] ACETBC, Tokyo, Japan

[3] Addenbrookes Hosp, Cambridge, England

[4] AGO Breast Study Grp, Rheingauviertel, Germany

[5] Anglocelt Cooperat Oncol Grp, Merseyside, England

[6] ARCOSEIN Grp, Toledano, France

[7] ATLAS Trial Collaborat Study Grp, Oxford, England

[8] Auckland Breast Canc Study Grp, Auckland, New Zealand

[9] Australian New Zealand Breast Canc Trials Grp, Sydney, NSW, Australia

[10] Austrian Breast Canc Study Grp, Vienna, Austria

[11] Beatson Oncol Ctr, Glasgow, Lanark, Scotland

[12] Belgian Adjuvant Breast Canc Project, Liege, Belgium

[13] Berlin Buch Akad Wissensch, Berlin, Germany

[14] Birmingham Gen Hosp, Birmingham, W Midlands, England

[15] Bordeaux Inst Bergonie, Bordeaux, France

[16] Bordet Inst, Brussels, Belgium

[17] Bradford Roy Infirm, Bradford, W Yorkshire, England

[18] BCIRG, Brussels, Belgium

[19] Comprehensive Canc Ctr, Breast Canc Study Grp, Limberg, Netherlands

[20] British Assoc Surg Oncol BASO II Trialists, London, England

[21] British Columbia Canc Agcy, Vancouver, BC, Canada

[22] Canadian Canc Trials Grp, Kingston, ON, Canada

[23] Cancer and Leukemia Grp B, Washington, DC USA

[24] Canc Care Ontario, Torrance, CA USA

[25] Russian Acad Med Sci, Canc Res Ctr, Moscow, Russia

[26] NCRI, CRCTU, Birmingham, W Midlands, England

[27] Cardiff Trialists Grp, Cardiff, S Glam, Wales

[28] Case Western Reserve Univ, Cleveland, OH 44106 USA

[29] Cent Oncol Grp, Milwaukee, WI USA

[30] Queen Mary Univ London, Wolfson Inst Prevent Med, Ctr Canc Prevent, London, England

[31] Ctr Leon Berard, Lyon, France

[32] Ctr Paul Lamarque, Montpellier, France

[33] Ctr Reg Francois Baclesse, Caen, France

[34] Ctr Oncol, Trieste, Italy

[35] Charles Univ Prague, Fac Med 1, Dep Oncol, Gen Teaching Hosp, Prague, Czech Republic

[36] Cheltenham Gen Hosp, Cheltenham, Glos, England

[37] Univ Chicago, Chicago, IL 60637 USA

[38] Chinese Acad Med Sci, Beijing, Peoples R China

[39] MRC PHRU, Oxford, England

[40] Christie Hosp, Manchester, Lancs, England

[41] Holt Radium Inst, Manchester, Lancs, England

[42] Coimbra Inst Oncol, Coimbra, Portugal

[43] Copenhagen Breast Canc Trials, Copenhagen, Denmark

[44] Dana Farber Canc Inst, Boston, MA USA

[45] Danish Breast Canc Cooperat Grp, Copenhagen, Denmark

[46] Dusseldorf Univ, Dusseldorf, Germany

[47] Dutch Working Party Autologous Bone Marrow Transp, Amsterdam, Netherlands

[48] Dutch Working Party Autologous Bone Marrow Transp, Groningen, Netherlands

[49] Eastern Cooperat Oncol Grp, Boston, MA USA

[50] Edinburgh Breast Unit, Edinburgh, Midlothian, Scotland

来源：

LANCET ONCOLOGY | 2018年 / 19卷 / 01期

基金：

英国医学研究理事会;

关键词：

STIMULATING FACTOR; THERAPY; METHOTREXATE;

D O I：

10.1016/S1470-2045(17)30777-5

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 [肿瘤学];

摘要：

Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21.4% for NACT versus 15.9% for adjuvant chemotherapy (5.5% increase [95% CI 2.4-8.6]; rate ratio 1.37 [95% CI 1.17-1.61]; p = 0.0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38.2% for NACT vs 38.0% for adjuvant chemotherapy; rate ratio 1.02 [95% CI 0.92-1.14]; p = 0.66), breast cancer mortality (34.4% vs 33.7%; 1.06 [0.95-1.18]; p = 0.31), or death from any cause (40.9% vs 41.2%; 1.04 [0.94-1.15]; p = 0.45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. Copyright (c) The Author(s). Published by Elsevier Ltd.

引用

页码：27 / 39

页数：13

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