在“现实世界”中采用新辅助化疗（NACT）的研究很少。本研究的目的是调查意大利的 NACT 率、随时间变化的趋势以及治疗选择的决定因素。Senonetwork 是意大利公认的乳腺中心网络，开发了一个自愿国家数据库，旨在监测和提高治疗质量。对参与该项目的 24 个高容量乳腺中心在 2017 年至 2022 年间治疗的 58,661 名乳腺癌 (BC) 患者进行了回顾性分析。在子集排除后，对 37,215 名原发性 BC 患者进行了分析，其中 32,933 名患者接受了初次乳房手术，4,282 名患者接受了乳腺癌手术。接受了 NACT。从 2017 年到 2022 年，总体 NACT 发生率有所增加，尤其是 HR-/HER2、三阴性和 HR/HER2 BC (p < 0.001)。在 cN 患者中，NACT 后腋窝淋巴结清扫的建议随着时间的推移而减少，同时切除的淋巴结数量增加了 <4 个 (p < 0.001)。随着时间的推移，立即乳房重建和保留乳头乳房切除术的指征显着增加（分别为 OR = 1.10，p = 0.011 和 OR 1.14，p < 0.001）。多变量分析显示，HR-/HER2 (p = 0.01) 和三阴性肿瘤 (p = 0.06) 保守治疗的采用率呈增加趋势。 NACT 的实施情况在乳腺中心之间存在显着差异，从 3.8% 到 17.7%（p < 0.001）。NACT 对后续手术管理的影响很大，并且随着时间的推移不断发展，从而导致手术范围缩小。即使在高容量中心中，NACT 实施率仍然存在很大差异。尽管我们在研究期间其使用量显着增加，但这些结果需要进一步改进。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

Adoption of neoadjuvant chemotherapy (NACT) in the "real world" has been poorly investigated. Aim of this study was to examine the rate of NACT in Italy, trends over time and determinants of therapeutic choices.Senonetwork, the recognized network of Breast Centers in Italy, has developed a voluntary national data warehouse with the aim to monitor and improve treatments quality. A retrospective analysis was conducted among 58,661 breast cancer (BC) patients treated between 2017 and 2022 by 24 high-volume Breast Centers participating in the project.After subset exclusion, 37,215 primary BC patients were analysed, 32,933 underwent primary-breast-surgery and 4,282 underwent NACT. From 2017 to 2022, the overall NACT incidence increased particularly for HR-/HER2+, Triple-Negative, and HR+/HER2+ BC (p < 0.001). In cN + patients the recommendation to axillary lymph-node dissection after NACT decreased over time along with an increase of <4 lymph-nodes removed (p < 0.001). Immediate breast reconstruction and indication for nipple sparing mastectomy increased significantly over time (OR = 1.10, p = 0.011 and OR 1.14, p < 0.001, respectively). On multivariate analysis, there was a trend towards an increased adoption of conservative treatment for HR-/HER2+ (p = 0.01) and Triple Negative tumors (p = 0.06). Implementation of NACT varied significantly among Breast-Centers from 3.8 to 17.7 % (p < 0.001).The impact of NACT on the subsequent surgical management is substantial and continues to evolve over time, resulting in less-extensive surgery. Even among high-volume Centers NACT implementation rate is still highly variable. Although we registered a significant increase in its use during the study period, these results need to be further improved.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.