Prognosis and influencing factors of neoadjuvant chemotherapy and adjuvant chemotherapy for T1-2N1-2M0 luminal breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Ran ¹ , CHEN Hongyu ¹ , PU Zhuo ¹ , LIU Jun ² ,  ZHAO Xiaobo ¹

1. Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

ZHAO Xiaobo, Email: zhaoxb.823@163.com

Keywords：

luminal breast cancer; neoadjuvant chemotherapy; adjuvant chemotherapy; prognosis

DOI：

10.7507/1007-9424.202502002

Video：

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Objective To compare the prognosis of neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) in patients with T1-2N1-2M0 luminal breast cancer, and to analyze the factors affecting the prognosis. Methods Patients with luminal breast cancer who met the inclusion criteria and had complete follow-up data from January 2014 to December 2019 were retrospectively collected. Patients received either neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC), both based on anthracycline-containing regimens. Kaplan-Meier analysis was performed to estimate survival, and Cox proportional hazards regression was used to identify risk factors affecting 5-year cumulative overall survival rate. The significance level was set at α=0.05. Results A total of 206 patients (99 receiving NAC and 107 receiving AC) who met the inclusion criteria were enrolled. The cohort comprised 101 patients with luminal A (57 AC, 44 NAC) and 105 with luminal B (50 AC, 55 NAC). At a median follow-up of 72.5 months, no significant difference in the 5-year cumulative overall survival rate was observed between AC and NAC patients (89.7% vs. 88.9%, P=0.571); However, the 5-year cumulative disease-free survival rate was significantly higher in the AC group as compared with the NAC group (85.0% vs. 73.5%, P<0.001). Subgroup analysis demonstrated that no significant differences in the 5-year cumulative overall survival rates between AC and NAC patients within either luminal A (94.7% vs. 86.4%, P=0.727) or luminal B (84.0% vs. 89.3%, P=0.864). However, for patients with luminal A, the 5-year cumulative disease-free survival rate was significantly higher in the AC subgroup than in the NAC subgroup (93.0% vs. 77.3%, P<0.001). In contrast, no significant difference in the 5-year cumulative disease-free survival rate between AC and NAC patients was observed in patients with luminal B (74.0% vs. 71.4%, P=0.201). Multivariate analysis using the Cox proportional hazards model identified the following independent risk factors for lower 5-year cumulative overall survival rate in patients with T1-2N1-2M0 luminal breast cancer: N2 stage [HR (95%CI)=2.290 (1.249, 4.196)], lymphovascular invasion [HR (95%CI)=2.181 (1.182, 4.026)], omission of endocrine therapy [HR (95%CI)=6.013 (2.590, 13.965)], and absence of pathological complete response after NAC [HR (95%CI)=2.403 (1.284, 4.496)]. Conclusions The results of this study suggest that patients with T1-2N1-2M0 luminal breast cancer can achieve higher disease-free survival from AC. But it is still necessary to comprehensively consider the patient’s condition such as lymph node metastasis, vascular cancer thrombus to formulate an individualized treatment plan to increase the overall survival rate of patients.

Citation： ZHANG Ran, CHEN Hongyu, PU Zhuo, LIU Jun, ZHAO Xiaobo. Prognosis and influencing factors of neoadjuvant chemotherapy and adjuvant chemotherapy for T1-2N1-2M0 luminal breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(8): 984-990. doi: 10.7507/1007-9424.202502002 Copy

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2.	Moreno-Aspitia A. Neoadjuvant therapy in early-stage breast cancer. Crit Rev Oncol Hematol, 2012, 82(2): 187-199.
3.	Fisher B, Gunduz N, Coyle J, et al. Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res, 1989, 49(8): 1996-2001.
4.	Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
5.	Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA, 2013, 310(14): 1455-1461.
6.	Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol, 2018, 19(1): 27-39.
7.	Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol, 1997, 15(7): 2483-2493.
8.	Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
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11.	Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
12.	Qiu P, Sheng J. A two-stage procedure for comparing hazard rate functions. J R Stat Soc Series B Stat Methodol, 2008, 70(1): 191-208.
13.	van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer Trial 10902. J Clin Oncol, 2001, 19(22): 4224-4237.
14.	Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Ann Surg Oncol, 2016, 23(11): 3467-3474.
15.	Yau C, Osdoit M, van der Noordaa M, et al. Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5 161 patients. Lancet Oncol, 2022, 23(1): 149-160. doi: 10.1016/S1470-2045(21)00589-1.
16.	Li X, Dai D, Chen B, et al. Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 210. doi: 10.1186/s12957-017-1277-2.
17.	Read RL, Flitcroft K, Snook KL, et al. Utility of neoadjuvant chemotherapy in the treatment of operable breast cancer. ANZ J Surg, 2015, 85(5): 315-320.
18.	Shang Y, Wang X, Liu Y, et al. Comparing survival outcomes between neoadjuvant and adjuvant chemotherapy within T2N1M0 stage hormone receptor-positive, HER2-negative breast cancer: a retrospective cohort study based on SEER database. Breast Cancer, 2024, 31(4): 684-694.
19.	施杰, 李云涛, 高海燕. 腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析. 中华乳腺病杂志(电子版), 2023, 17(6): 353-361.
20.	Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol, 2023, 41(10): 1795-1808.
21.	Boughey JC, Hoskin TL, Goetz MP. Neoadjuvant chemotherapy and nodal response rates in luminal breast cancer: efects of age and tumor Ki67. Ann Surg Oncol, 2022, 29(9): 5747-5756.
22.	Colleoni M, Bagnardi V, Rotmensz N, et al. A nomogram based on the expression of Ki-67, steroid hormone receptors status and number of chemotherapy courses to predict pathological complete remission after preoperative chemotherapy for breast cancer. Eur J Cancer, 2010, 46(12): 2216-2224.
23.	Copson E, Eccles B, Maishman T, et al. Prospective observational study of breast cancer treatment outcomes for UK women aged 18–40 years at diagnosis: the POSH study. J Natl Cancer Inst, 2013, 105(13): 978-988.
24.	Du L, Yau C, Brown-Swigart L, et al. Predicted sensitivity to endocrine therapy for stage Ⅱ–Ⅲ hormone receptor-positive and HER2-negative (HR⁺/HER2^–) breast cancer before chemo-endocrine therapy. Ann Oncol, 2021, 32(5): 642-651.
25.	Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet, 2005, 365(9472): 1687-1717.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Moreno-Aspitia A. Neoadjuvant therapy in early-stage breast cancer. Crit Rev Oncol Hematol, 2012, 82(2): 187-199.
3. Fisher B, Gunduz N, Coyle J, et al. Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res, 1989, 49(8): 1996-2001.
4. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
5. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA, 2013, 310(14): 1455-1461.
6. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol, 2018, 19(1): 27-39.
7. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol, 1997, 15(7): 2483-2493.
8. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
9. Stankowski-Drengler TJ, Livingston-Rosanoff D, Schumacher JR, et al. Breast cancer outcomes of neoadjuvant versus adjuvant chemotherapy by receptor subtype: a scoping review. J Surg Res, 2020, 254: 83-90.
10. van Nes JG, Putter H, Julien JP, et al. Preoperative chemotherapy is safe in early breast cancer, even after 10 years of follow-up; clinical and translational results from the EORTC trial 10902. Breast Cancer Res Treat, 2009, 115(1): 101-113.
11. Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
12. Qiu P, Sheng J. A two-stage procedure for comparing hazard rate functions. J R Stat Soc Series B Stat Methodol, 2008, 70(1): 191-208.
13. van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer Trial 10902. J Clin Oncol, 2001, 19(22): 4224-4237.
14. Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Ann Surg Oncol, 2016, 23(11): 3467-3474.
15. Yau C, Osdoit M, van der Noordaa M, et al. Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5 161 patients. Lancet Oncol, 2022, 23(1): 149-160. doi: 10.1016/S1470-2045(21)00589-1.
16. Li X, Dai D, Chen B, et al. Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis. World J Surg Oncol, 2017, 15(1): 210. doi: 10.1186/s12957-017-1277-2.
17. Read RL, Flitcroft K, Snook KL, et al. Utility of neoadjuvant chemotherapy in the treatment of operable breast cancer. ANZ J Surg, 2015, 85(5): 315-320.
18. Shang Y, Wang X, Liu Y, et al. Comparing survival outcomes between neoadjuvant and adjuvant chemotherapy within T2N1M0 stage hormone receptor-positive, HER2-negative breast cancer: a retrospective cohort study based on SEER database. Breast Cancer, 2024, 31(4): 684-694.
19. 施杰, 李云涛, 高海燕. 腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析. 中华乳腺病杂志(电子版), 2023, 17(6): 353-361.
20. Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol, 2023, 41(10): 1795-1808.
21. Boughey JC, Hoskin TL, Goetz MP. Neoadjuvant chemotherapy and nodal response rates in luminal breast cancer: efects of age and tumor Ki67. Ann Surg Oncol, 2022, 29(9): 5747-5756.
22. Colleoni M, Bagnardi V, Rotmensz N, et al. A nomogram based on the expression of Ki-67, steroid hormone receptors status and number of chemotherapy courses to predict pathological complete remission after preoperative chemotherapy for breast cancer. Eur J Cancer, 2010, 46(12): 2216-2224.
23. Copson E, Eccles B, Maishman T, et al. Prospective observational study of breast cancer treatment outcomes for UK women aged 18–40 years at diagnosis: the POSH study. J Natl Cancer Inst, 2013, 105(13): 978-988.
24. Du L, Yau C, Brown-Swigart L, et al. Predicted sensitivity to endocrine therapy for stage Ⅱ–Ⅲ hormone receptor-positive and HER2-negative (HR⁺/HER2^–) breast cancer before chemo-endocrine therapy. Ann Oncol, 2021, 32(5): 642-651.
25. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet, 2005, 365(9472): 1687-1717.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prognosis and influencing factors of neoadjuvant chemotherapy and adjuvant chemotherapy for T1-2N1-2M0 luminal breast cancer

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