意大利乳腺癌的新辅助化疗：2017年至2022年接受治疗的37,215例患者的senonetwork分析
Neoadjuvant chemotherapy for breast cancer in Italy: A Senonetwork analysis of 37,215 patients treated from 2017 to 2022
影响因子:7.90000
分区:医学2区 / 妇产科学2区 肿瘤学2区
发表日期:2024 Dec
作者:
A De Luca, M I Amabile, F Santori, S Di Matteo, M Tomatis, A Ponti, F Frusone, M Taffurelli, C Tinterri, L Marotti, M Calabrese, C Marchiò, F Puglisi, I Palumbo, L Fortunato,
摘要
在“现实世界”中采用新辅助化学疗法（NACT）的研究很少。这项研究的目的是检查意大利的NACT速度，随着时间的推移趋势和治疗选择的决定因素。Senonetwork是意大利公认的乳房中心网络，已开发出一个自愿的国家数据仓库，旨在监测和提高治疗质量。在2017年至2022年之间的58,661例乳腺癌（BC）患者中进行了回顾性分析，由24个参加该项目的大量乳房中心进行。在子集排除后，分析了37,215例BC患者，分析了32,933例BC患者，32,933例接受了初级野外手术和4,282的妇女。从2017年到2022年，尤其是HR-/HER2+，三重阴性和HR+/HER2+BC（p <0.001）的总体NACT发病率增加。在CN+患者中，NACT后腋窝淋巴结清扫术的建议随着时间的推移降低，而去除<0.001）。随着时间的推移，乳头保留乳房切除术的立即重建和指示显着增加（OR = 1.10，p = 0.011和OR 1.14，p <0.001）。在多变量分析中，有一种趋势是增加对HR-/HER2+（P = 0.01）和三重阴性肿瘤（P = 0.06）的保守治疗的采用趋势。乳房中心的NACT实施从3.8％到17.7％（P <0.001）差异很大。NACT对随后的手术管理的影响很大，并且随着时间的流逝而继续发展，导致手术较少。即使在大批量中心中，NACT实施率仍然很大。尽管我们在研究期间注册了其使用的大幅度增加，但这些结果需要进一步改善。
Abstract
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.