ZHANG Ran 1 , CHEN Hongyu 1 , PU Zhuo 1 , LIU Jun 2 , ZHAO Xiaobo 1
  • 1. Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
  • 2. North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
ZHAO Xiaobo, Email: zhaoxb.823@163.com
luminal breast cancer; neoadjuvant chemotherapy; adjuvant chemotherapy; prognosis
10.7507/1007-9424.202502002
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Objective To compare the prognosis of neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) in patients with T1-2N1-2M0 luminal breast cancer, and to analyze the factors affecting the prognosis. Methods Patients with luminal breast cancer who met the inclusion criteria and had complete follow-up data from January 2014 to December 2019 were retrospectively collected. Patients received either neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC), both based on anthracycline-containing regimens. Kaplan-Meier analysis was performed to estimate overall survival, and Cox proportional hazards regression was used to identify risk factors affecting 5-year cumulative overall survival rate. Statistical significance was defined as a P=0.05.Results A total of 206 patients (99 receiving NAC and 107 receiving AC) meeting the inclusion criteria were enrolled. The cohort comprised 101 patients with luminal A (57 AC, 44 NAC) and 105 with luminal B (50 AC, 55 NAC). At a median follow-up of 72.5 months, no significant differences in the 5-year cumulative overall survival rates were observed between AC and NAC patients (89.7% vs. 88.9%, P=0.571). However, the 5-year cumulative disease-free survival rate was significantly higher in the AC group as compared with the NAC group (85.0% vs. 73.5%, P<0.001). Subgroup analysis demonstrated no significant differences in the 5-year cumulative overall survival rates between AC and NAC patients within either luminal A (94.7% vs. 86.4%, P=0.727) or luminal B (84.0% vs. 89.3%, P=0.864). However, for patients with luminal A, the 5-year cumulative disease-free survival rate was significantly higher in the AC subgroup than in the NAC subgroup (93.0% vs. 77.3%, P<0.001). In contrast, no significant difference in the 5-year cumulative disease-free survival rate between AC and NAC was observed among patients with luminal B (74.0% vs. 71.4%, P=0.201). Multivariate analysis using the Cox proportional hazards model identified the following independent risk factors for lower 5-year cumulative overall survival rate in patients with T1-2N1-2M0 luminal breast cancer: N2 stage [HR (95%CI)=2.290 (1.249, 4.196)], lymphovascular invasion [HR (95%CI)=2.181 (1.182, 4.026)], omission of endocrine therapy [HR (95%CI)=6.013 (2.590, 13.965)], and absence of pathological complete response (pCR) after NAC [HR (95%CI)=2.403 (1.284, 4.496)]. Conclusion The results of this study suggest that patients with T1-2N1-2M0 luminal breast cancer can achieve higher disease-free survival from AC, but it is still necessary to comprehensively consider the patient’s condition such as lymph node metastasis, vascular cancer thrombus, and other factors to formulate an individualized treatment plan to increase the overall survival rate of patients.

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