局部晚期乳腺癌 (LABC) 的治疗选择有限，具有挑战性。本研究在现实世界队列中调查了前期手术与新辅助化疗 (NAC) 相比的可行性和长期结果。这项回顾性研究分析了 243 名无法手术的 LABC 患者（不包括 T3N1M0），他们在匹配组中接受了前期手术 (n = 187) 或 NAC (n = 56)。无病生存期（DFS）和总生存期（OS）是主要结局。次要结局包括 NAC 反应率和基于年龄、肿瘤分期和治疗反应的亚组分析。使用 Kaplan-Meier 方法和对数秩检验来估计生存率以进行比较。 Cox比例风险模型用于亚组分析。中位随访时间为 60.9 个月，5 年 OS 率（前期手术：89.6%，NAC：81.9%，p= .12）或 5 年 DFS 率（73.0% vs. 67.1%， p = .24)。亚组分析显示，对于 60 岁以下患者 (HR = 0.32；95% CI：0.10-0.96；p = .0429) 和 IIIA 期疾病 (HR = 0.22；CI：0.06-0.86；p = .03)，前期手术可显着改善 OS。 ）。前期手术显示 5 厘米以下肿瘤的 OS 呈改善趋势（HR= 0.37；95% CI：0.13-1.03；p= .056）。 NAC 后疾病进展 (PD) 或疾病稳定 (SD) 患者的 DFS (HR = 0.27; 95% CI: 0.09-0.79; p = .017) 和 OS (HR = 0.09; 95% CI: 0.02- 0.48；p = .004）与响应者相比。前期手术对于 LABC 患者可能是可行的，尤其是年轻患者、IIIA 期疾病或较小肿瘤的患者。 NAC 反应可以为治疗决策提供信息。这些发现强调了考虑患者特征和 NAC 反应进行个性化 LABC 治疗的必要性。© 2024 作者。约翰·威利出版的《国际癌症杂志》

Locally advanced breast cancer (LABC) is challenging with limited treatment options. This study investigates the feasibility and long-term outcomes of upfront surgery compared to neoadjuvant chemotherapy (NAC) in a real-world cohort. This retrospective study analyzed 243 inoperable LABC patients (excluding T3N1M0) that underwent upfront surgery (n = 187) or NAC (n = 56) in matched groups. Disease-free survival (DFS) and overall survival (OS) are primary outcomes. Secondary outcomes included NAC response rate and subgroup analyses based on age, tumor stage, and treatment response. Survival was estimated using Kaplan-Meier methods with log-rank tests for comparisons. Cox proportional hazards models were used for subgroup analyses. With a median follow-up of 60.9 months, no significant difference emerged in 5-year OS (upfront surgery: 89.6%, NAC: 81.9%, p = .12) or 5-year DFS rates (73.0% vs. 67.1%, p = .24). Subgroup analyses revealed upfront surgery offered significantly better OS for patients under 60 (HR = 0.32; 95% CI: 0.10-0.96; p = .0429) and stage IIIA disease (HR = 0.22; CI: 0.06-0.86; p = .03). Upfront surgery showed a trend towards improved OS for tumors under 5 cm (HR = 0.37; 95% CI: 0.13-1.03; p = .056). Patients with progressive disease (PD) or stable disease (SD) after NAC had significantly worse DFS (HR = 0.27; 95% CI: 0.09-0.79; p = .017) and OS (HR = 0.09; 95% CI: 0.02-0.48; p = .004) compared to responders. Upfront surgery may be viable for LABC patients, particularly younger patients, those with stage IIIA disease, or smaller tumors. NAC response can inform treatment decisions. These findings highlight the need for personalized LABC treatment considering patient characteristics and NAC response.© 2024 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.