一种创新的评分系统，用于选择新辅助化疗后乳腺癌的最佳手术方案。
An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy.
发表日期：2023 Aug 21
作者：
Antonio Franco, Alba Di Leone, Marco Conti, Alessandra Fabi, Luisa Carbognin, Andreina Daniela Terribile, Paolo Belli, Armando Orlandi, Martin Alejandro Sanchez, Francesca Moschella, Elena Jane Mason, Giovanni Cimino, Alessandra De Filippis, Fabio Marazzi, Ida Paris, Giuseppe Visconti, Liliana Barone Adesi, Lorenzo Scardina, Sabatino D'Archi, Marzia Salgarello, Diana Giannarelli, Riccardo Masetti, Gianluca Franceschini
来源：
PHYSICAL THERAPY & REHABILITATION JOURNAL
摘要：
手术术后选择新辅助化学治疗（NACT）是一个困难的问题，取决于外科医生的专长。本研究旨在建立一种术后新辅助评分系统（pNESSy），用于选择手术，以优化肿瘤和美学效果。收纳病人（I-III期）接受术后NACT手术（包括保乳手术（BCS），整形手术（OPS）和保守性乳腺切除术（CMR））。选取的数据包括BRCA突变、下垂、乳房容积、放射学反应、MRI和乳腺摄影前后NACT预测切除乳房面积。依据这些数据与手术之间的关联创建了pNESSy。评估了曲线下面积（AUC）。根据评分与手术之间的对应（G1）或不对应（G2），将病人分为不同的组别，分析了肿瘤学和美学结果。共纳入255例病人（BCS：118例，OPS：49例，CMR：88例）。pNESSy在6.896-8.724之间预测BCS，在8.725-9.375之间预测OPS，在9.376-14.245之间预测CMR；对应的AUC分别为0.835、0.766和0.825。与手术结果一致（G1）组具有较低的涉及切缘发生率（5-14.7%；p = 0.010），更好的局部-区域无病生存（98.8-88.9%；p < 0.001），更好的总生存（96.1-86.5%；p = 0.017），以及更好的对乳房满意度（39.8-27.5%；p = 0.017）和身体健康状况（93.5-73.6%；p = 0.001）。基于临床和放射学特征的评分系统被创建，用于选择术后最佳手术方式，以改善肿瘤和美学结果。
The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons' expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes.Patients (stage I-III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed.A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896-8.724 was predictive for BCS, 8.725-9.375 for OPS, and 9.376-14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5-14.7%; p = 0.010), a better locoregional disease-free survival (98.8-88.9%; p < 0.001) and a better overall survival (96.1-86.5%; p = 0.017), and a better satisfaction with breasts (39.8-27.5%; p = 0.017) and physical wellbeing (93.5-73.6%; p = 0.001).A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.