Objective To systematically evaluate the efficacy and safety of dose-dense neoadjuvant chemotherapy (ddNACT) and conventional neoadjuvant chemotherapy (cNACT) for locally advanced breast cancer (LABC). Methods PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP databases were searched for randomized controlled trials (RCT) comparing ddNACT regimen with cNACT regimen for breast cancer. The time limit for retrieval was from establishment to March 1st, 2021. Two reviewers independently screened literatures, extracted data and assessed risk bias of included studies; then, meta-analysis was performed by using Stata 15.0 software. Results A total of 13 RCTs were included, including 3 258 patients, of which 1 625 patients received ddNACT and 1 633 patients received cNACT. The results of meta-analysis showed that the ddNACT regimen could improve the pathological complete response rate (pCR, P<0.001), objective response rate (ORR, P<0.001), and disease free survival (DFS, P=0.037) as compared with the cNACT regimen, there was no significant difference in the overall survival (OS) between the two groups (P=0.098). The incidences of grade 3 or 4 oral stomatitis (P=0.005) and neurotoxicity (P<0.001) were higher and the incidence of grade 3 or 4 neutropenia was lower (P=0.025) in the patients with ddNACT regimen, there were no significant differences in grade 3 or 4 thrombocytopenia (P=0.152), grade 3 or 4 anemia (P=0.123), chemotherapy completion rate (P=0.161) and breast conservative surgery rate (P=0.186) between the two groups. Patients with hormone receptor (HR) negative (HR–) were more likely to get pCR after neoadjuvant chemotherapy (P<0.001). ConclusionsCurrent evidence shows that the use of anthracycline/taxane-based ddNACT regimen in LABC patients can improve the pCR, ORR, and DFS as compared with cNACT regimen. The pCR after neoadjuvant chemotherapy in the patients with HR– is higher than that with HR+. Prophylactic use of granulocyte-colony stimulating factor could significantly reduce the incidence of neutropenia, and most patients are tolerant to ddNACT regimen, 2 regimens have similar chemotherapy completion rates.
ObjectiveTo analyze the factors influencing axillary pathological complete response (pCR) after neoadjuvant therapy (NAT) and to provide the possibility of exempting axillary surgery for patients with better pathological efficacy of primary breast lesions after NAT. MethodsAccording to the inclusion and exclusion criteria, the patients with breast cancer admitted to the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from January 1, 2020 to June 30, 2022 were retrospectively analyzed. All patients were diagnosed with ipsilateral axillary lymph node metastasis of breast cancer and the NAT cycle was completed according to standards. All patients underwent axillary lymph node dissection (ALND) after NAT. The therapeutic effect of primary breast lesions was evaluated by Miller-Payne (MP) grading system. The axillary pCR was judged according to whether there was residual positive axillary lymph nodes after ALND. The unvariate and multivariate logistic regressions were used to analyze the risk factors affecting the axillary pCR. At the same time, the possibility of exempting axillary surgery after NAT in the MP grade 5 or in whom without ductal carcinoma in situ (DCIS) was evaluated. The ALND was considered to exempt when the negative predictive value was 90% or more and false negative <10% or almost same. ResultsA total of 111 eligible patients with breast cancer were gathered in the study, 64 of whom with axillary pCR. There were 43 patients of MP grade 5 without DCIS after NAT, 41 of whom were axillary pCR. The univariate analysis results showed that the estrogen receptor and progesterone receptor statuses, molecular type, NAT regimen, and MP grade were associated with the axillary pCR after NAT, then the logistic regression multivariate analysis results showed that the MP grade ≤3 and MP grade 4 decreased the probability of axillary pCR as compared with the MP grade 5 [OR=0.105, 95%CI (0.028, 0.391), P=0.001; OR=0.045, 95%CI (0.012, 0.172), P<0.001]. There were 51 patients of MP grade 5 after NAT, 46 of whom were axillary pCR. The negative predictive value and the false negative rate of MP grade 5 on predicting the postoperative residual axillary lymph nodes were 90.2% [95%CI (81.7%, 98.6%)] and 10.6% [95%CI (1.5%, 19.8%)], respectively, which of MP grade 5 without DCIS were 95.3% [95%CI (88.8%, 101.9%)] and 4.3% [95%CI (–1.7%, 10.2%)] , respectively. ConclusionsThe probability of axillary pCR for the patient with higher MP grade of breast primary after NAT is higher. It is probable of exempting axillary surgery when MP grade is 5 after NAT.
ObjectiveTo investigate the influencing factors of total pathological complete response (tpCR) in newly treated human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients after neoadjuvant targeted chemotherapy, so as to provide more reference for the formulation of surgical plan and prognosis assessment. MethodsNinety-five newly treated HER2-positive breast cancer patients after neoadjuvant targeted chemotherapy were retrospectively chosen in the period from January 2021 to January 2023 in our hospital and all patients were divided into tpCR group (51 cases) and non-tpCR group (44 cases) according to whether tpCR was achieved after neoadjuvant targeted chemotherapy or not. Univariate and multivariate methods were used to evaluate the independent influencing factors of tpCR after neoadjuvant targeted chemotherapy in newly treated HER2-positive breast cancer patients. The prediction model based on the above independent influencing factors was constructed and the potential predictive efficacy of this model for tpCR after neoadjuvant targeted chemotherapy was evaluated. ResultsAmong 95 patients, 51 patients achieved tpCR after neoadjuvant targeted chemotherapy and 44 patients did not achieve tpCR. The results of the multivariate logistic regression model analysis showed that the patients with HER2 3+(OR=6.102, P=0.014), HER2+/hormone receptor– (HER2+/hormone receptor+ OR=0.129, P=0.006), and trastuzumab+pantomizumab treatment (OR=6.582, P=0.014) had higher tpCR rate, estrogen receptor 3+ (OR=0.122, P=0.0.033), progesterone receptor 3+ (OR=0.179, P=0.020), Ki-67 index of 15%–30% (OR=0.088, P=0.030) and 31%–60% (OR=0.066, P=0.017) had lower tpCR rate. The predicted area under the curve of this model was 0.881 [95%CI (0.815, 0.947)]. ConclusionsThe achievement of tpCR after new adjuvant treatment in newly diagnosed HER2 positive breast cancer patients is related to the expression level of HER2 in immunohistochemistry, molecular typing and new adjuvant targeted treatment scheme. At the same time, the prediction model based on these influencing factors can predict the effect of tpCR after new adjuvant treatment in patients to a certain extent.
ObjectiveTo analyze the association between nutritional and immune-related laboratory indices and pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients and focused on constructing a combination of laboratory indices to serve as a clinical predictor of pCR after NAC in breast cancer. MethodsRetrospectively collected the pre-NAC laboratory indices [albumin (ALB), total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, apolipoprotein A- Ⅰ, apolipoprotein B, white blood cell, neutrophil, lymphocyte, monocyte (MON), and platelet ] and clinicopathologic data of 310 patients with invasive breast cancer who had received NAC in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, from September 1, 2020 to October 31, 2022. Logistic regression analysis was conducted to determine the correlation between laboratory indices and post-NAC pCR. The combinations of laboratory indices were constructed by simple mathematical operation. The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of different combinations of laboratory indices in predicting pCR and to determine the optimal combination of liboratory indices. Multivariate logistic regression analysis was used to analysis the relevance between clinicopathologic features and post-NAC pCR in breast cancer patients and to determine the independent predictor of post-NAC pCR. ResultsAmong the 310 patients, 49.4% (153/310) of them achieved pCR after NAC. Logistic regression analysis revealed that ALB (Z=5.203, P<0.001) and HDL-C (Z=2.129, P=0.033) were positively correlated with post-NAC pCR, while MON (Z=–4.883, P<0.001) was negatively correlated with post-NAC pCR. The AUC analysis of 6 different combinations of laboratory indices showed that the ALB/MON combination (the optimal combination of liboratory indices) had the highest predictive performance (median AUC=0.708) and was determined to be the neoadjuvant therapy predictive index (NTPI). Multivariate logistic regression analysis showed that estrogen receptor (Z=–3.273, P=0.001), human epidermal growth factor 2 (Z=7.041, P<0.001), Ki-67 (Z=2.457, P=0.014), and NTPI (Z=4.661, P<0.001) were the independent predictors for post-NAC pCR. ConclusionNTPI could serve as a predictive index for post-NAC pCR in patients with breast cancer.
ObjectiveTo observe the accuracy of magnetic resonance imaging (MRI) for predicting pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer, and to analyze the cause of the prediction error.MethodsData from 157 breast cancer patients who underwent NAC before surgery in Mianyang Central Hospital from January 2017 to January 2019 were analyzed. MRI parameters before and after NAC and pCR conditions were collected to analyze the parameters that produced false positives and false negatives.ResultsOf the 157 patients, 37 (23.6%) achieved pCR after NAC, and 33 (21.0%) achieved radiation complete remission (rCR) after NAC. The accuracy of MRI prediction was 70.7% (111/157), the sensitivity was 82.5% (99/120), and the specificity was 32.4% (12/37). A total of 25 cases did not achieve rCR, but postoperative evaluation achieved pCR (false positive), 21 cases achieved rCR, but postoperative evaluation did not achieve pCR (false negative). Diameter of tumor, peritumoral oedema, and background parenchymal enhancement were associated with MRI false positive prediction (P<0.05); gland density and tumor rim enhancement were associated with MRI false negative prediction (P<0.05).ConclusionMRI can be used as an important method to predict pCR after NAC in breast cancer patients, and its accuracy may be related to diameter of tumor, peritumoral oedema, background parenchymal enhancement, gland density, and tumor rim enhancement.
ObjectiveTo explore the value of a decision tree (DT) model based on CT for predicting pathological complete response (pCR) after neoadjuvant chemotherapy therapy (NACT) in patients with locally advanced rectal cancer (LARC).MethodsThe clinical data and DICOM images of CT examination of 244 patients who underwent radical surgery after the NACT from October 2016 to March 2019 in the Database from Colorectal Cancer (DACCA) in the West China Hospital were retrospectively analyzed. The ITK-SNAP software was used to select the largest level of tumor and sketch the region of interest. By using a random allocation software, 200 patients were allocated into the training set and 44 patients were allocated into the test set. The MATLAB software was used to read the CT images in DICOM format and extract and select radiomics features. Then these reduced-dimensions features were used to construct the prediction model. Finally, the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), sensitivity, and specificity values were used to evaluate the prediction model.ResultsAccording to the postoperative pathological tumor regression grade (TRG) classification, there were 28 cases in the pCR group (TRG0) and 216 cases in the non-pCR group (TRG1–TRG3). The outcomes of patients with LARC after NACT were highly correlated with 13 radiomics features based on CT (6 grayscale features: mean, variance, deviation, skewness, kurtosis, energy; 3 texture features: contrast, correlation, homogeneity; 4 shape features: perimeter, diameter, area, shape). The AUC value of DT model based on CT was 0.772 [95% CI (0.656, 0.888)] for predicting pCR after the NACT in the patients with LARC. The accuracy of prediction was higher for the non-PCR patients (97.2%), but lower for the pCR patients (57.1%).ConclusionsIn this preliminary study, the DT model based on CT shows a lower prediction efficiency in judging pCR patient with LARC before operation as compared with homogeneity researches, so a more accurate prediction model of pCR patient will be optimized through advancing algorithm, expanding data set, and digging up more radiomics features.
ObjectiveTo summarize recent research on the surgical treatment of breast cancer after neoadjuvant chemotherapy (NAC) and to review the impact of NAC on the surgical treatment of breast cancer. MethodRelevant studies on NAC and surgical treatment of breast cancer from both domestic and international sources were reviewed. The literatures were analyzed, summarized, and discussed. ResultsFollowing NAC, the survival outcomes and risk of local recurrence in patients undergoing breast-conserving surgery were similar to those undergoing mastectomy. The using of image-guided minimally invasive biopsy accurately predicted pathological complete remission (pCR) of breast lesions after NAC, potentially allowed some breast cancer patients to undergo only radiation therapy after NAC, thus avoiding breast surgery. For patients with positive axillary lymph nodes, techniques such as dual-tracer, triple-tracer, and targeted axillary lymph node dissection had achieved clinical requirements in terms of detection rate and false-negative rate of sentinel lymph node biopsy, provided a safe alternative to axillary lymph node dissection. ConclusionsNAC is an important component of comprehensive breast cancer treatment. However, there is still controversy regarding the local treatment of the primary breast lesion and axillary lymph nodes after NAC. Currently, individualized treatment based on the specific circumstances of the patient remains the approach in clinical practice, aiming to achieve the optimal control of local recurrence and survival benefits for patients.
ObjectiveTo investigate the effect and predictive value of systemic inflammatory markers on pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for locally advanced breast cancer (LABC). MethodsThe clinicopathologic data of female patients with LABC who received NACT and radical surgical resection in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from February 2019 to February 2022 were retrospectively analyzed. The factors affecting pCR after NACT were analyzed by the multivariate logistic regression and the prediction model was established. The efficiency of the prediction model was evaluated by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). ResultsA total of 98 patients were gathered, of which 29 obtained pCR, with a pCR rate of 29.6%. The multivariate analysis of binary logistic regression showed that the patients with non-menopausal status, negative estrogen receptor (ER), chemotherapy+targeted therapy, and systemic immune-inflammation index (SII) <532.70 (optimal critical value) were more likely to obtain pCR after NACT (P<0.05). The prediction model was established according to logistic regression analysis: Logit (P)=0.697–2.974×(menopausal status)–1.932×(ER status)+3.277×(chemotherapy regimen)–2.652×(SII). The AUC (95%CI) of the prediction model was 0.914 (0.840, 0.961), P<0.001. ConclusionsIt is not found that other inflammatory indicators such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio are associated with pCR after NACT. But SII is an important predictor of pCR after NACT for LABC and has a good predictive efficiency.
Objective To observe the short-term efficacy and safety of neoadjuvant sintilimab combined with chemotherapy in the treatment of patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). MethodsClinical data were collected from patients with locally advanced resectable ESCC who received neoadjuvant immunotherapy combined with chemotherapy followed by surgical treatment at the Department of Thoracic Surgery of Jining First People's Hospital from April 2020 to April 2022. The endpoints included major pathological response (MPR), pathological complete response (pCR), R0 resection rate, safety, and postoperative survival. Results A total of 43 patients with ESCC who received at least one cycle of neoadjuvant immunotherapy before surgery were included. Among them, there were 31 males and 12 females, aged from 46 to 77 years, with a median age of 65 years. All patients successfully completed the surgery without any surgical delays. The pCR rate was 14.0% (6/43), the MPR rate was 58.1% (25/43), and the R0 resection rate was 97.7% (42/43). Patients exhibited reliable safety during neoadjuvant therapy and postoperatively. The 2-year overall survival and disease-free survival rates were 90.7% and 81.4%, respectively. Kaplan-Meier survival analysis and log-rank test revealed lower recurrence rates and better survival in the MPR group compared to the non-MPR group. Conclusion The combination of neoadjuvant sintilimab and chemotherapy in the treatment of patients with locally advanced resectable ESCC has demonstrated significant clinical efficacy, while also being safe and reliable.