意大利乳腺癌新辅助化疗：Senonetwork对37,215例患者（2017-2022年）治疗的分析

Neoadjuvant chemotherapy for breast cancer in Italy: A Senonetwork analysis of 37,215 patients treated from 2017 to 2022

BREAST

影响因子:7.9

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,

DOI: 10.1016/j.breast.2024.103790

摘要

在“实际临床”中采用新辅助化疗（NACT）的研究尚不充分。本研究旨在分析意大利NACT的使用率、时间趋势及治疗选择的决定因素。意大利乳腺中心网络（Senonetwork）建立了一个志愿性国家数据仓库，用于监测和改善治疗质量。在2017年至2022年期间，我们对来自24个高容量乳腺中心的58,661例乳腺癌患者进行了回顾性分析。经过筛选，纳入37,215例原发性乳腺癌患者，其中32,933例接受原发乳房手术，4,282例接受NACT。结果显示，2017年至2022年间，NACT的总体使用率逐年上升，尤其在HR-/HER2+、三阴性和HR+/HER2+乳腺癌中（p<0.001）。在cN+患者中，NACT后腋窝淋巴结清扫的建议逐渐减少，同时<4个淋巴结切除的比例增加（p<0.001）。早期乳房重建和乳头保留乳房切除术的指征显著增加（OR=1.10，p=0.011；OR=1.14，p<0.001）。多变量分析显示，保守治疗的采用趋势在HR-/HER2+（p=0.01）和三阴性肿瘤（p=0.06）中有所增加。NACT的实施比例在不同乳腺中心间差异显著，变化范围为3.8%至17.7%（p<0.001）。NACT对后续手术管理影响显著，且随着时间推移不断演变，导致手术范围缩小。即使在高容量中心，NACT的应用率仍高度差异。尽管研究期间NACT的使用显著增加，但仍需进一步优化和推广。

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.