Predioctors Of Locoregional Recurrence In Stage Ⅱ～Ⅲ Breast Cancer After Neoadjuvant Chemotherapy And Radiotherapy

Part I. Predioctors of Iocoregional recurrence(LRR) in stage Ⅱ-Ⅲ breast cancer after neoadjuvant chemotherapy(NAC) and postmastectomy radiotherapy(PMRT)Objective:The aim of this study was to investigate the factors of locoregional recurrence(LRR) in stage II-III breast cancer after neoadjuvant chemotherapy(NAC) and postmastectomy radiotherapy (PMRT) and to identify the high risk group patients.Methods:we retrospectively reviewed records from 332patients who received NAC and PMRT from April 2005 to April 2010. The tumor stage was IIA in 9.0%, IIB in 32.5%, IIIA in 40.4%, ⅢB 12.0%, ⅢC 6.0%(American Joint Committee on Cancer2010 system)。The 8-year cumulative incidence for events was calculated using Kaplan-Meier analysis and compared with Log-Rank test. Multivariate analysis was done using the Cox model.Result:The median patients age was 51 years (range,24-78 years). The median follow-up was 60.8 months. The 5-year cumulative LRR rate was 5%(95%CI,6.0%-12.3%).On univariate analysis, the clinical factors associated with LRR was initial T stage, initial N stage, combined clinical stage, hormone receptor, histological grade; the pathological factors associated with LRR was pathological complete respose, pathological N stage, and lymphvascular invasion. On Multivariate analysis, clinical T4 satge (P=0.04), clinical N2-3 stage, histological grade-Ⅲ (P=0.038), hormone receptor-negative (P=0.07), and four or more positive nodes (P=0.010) are independents factors associated with LRR. The 8-year cumulative LRR rate was only 2.3% for patients with one or none of these independent factors,10.8% for those with two factors, and 39.0% for those with three or more factors (p<0.0001) respectively.Conclusion:clinical T4 satge, clinical N2-3 stage, histological grade-Ⅲ, hormone receptor-negative, and four or more positive nodes were identified as independent risk factors for LRR after NAC and PMRT. Patients with three or more of these factors had high risk of LRR, maybe need to increase the intensity of local treatment.Part II. Loco-regional recurrence of Neoadjuvant chemotherapy combined with trastuzumab in stage Ⅱ-Ⅲ breast cancer treated with surgery and radiotherapyObj ective:Neoadjuvant chemotherapy combined with trastuzumab could significantly improved the pCR rate in HER2-positive breast cancers. The purpose of this study was to investigate whether the survival benefits from combined neoadjuvant chemotherapy could continue to loco-regional recurrence after surgery and radiotherapy.Methods:we retrospectively reviewed records from 123 patients in stage Ⅱ-Ⅲ HER2 positive breast cancer. All of the patients were treated with neoadjuvant chemotherapy、breast conserving surgery/mastectomy and radiotherapy. A total of 47 patients received neoadjuvant chemotherapy combined with trastuzumab, and 76 patients did not. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test., and multivariate analysis was done using the Cox model.Result:The median patients age was 52 years (range,25-78 years). The median follow-up was 52.0 months. The 5-year cumulative LRF、DFS and OS rates were 89.6%、75.5%、84.5%.On univariate analysis, the factors associated with LRR was initial N stage, pathological T stage, nerve-space invasion and chemotherapy only (P<0.05); the factors associated with DFS was initial N stage, pathological complete response, pathological T stage, nerve-space invasion and no chemotherapy only (P<0.05). On Multivariate analysis, clinical N2-3 stage (P=0.008), nerve-space invasion(P=0.014), no chemotherapy only (P=0.053) were independents factors associated with LRR. Clinical N2-3 stage (P=0.008), nerve-space invasion (P=0.001) were independent factors associated with DFS, and combined neoadjuvant chemotherapy or pathological complete response improved the DFS.Conclusion:Cinical N2-3 stage, nerve-space invasion and neoadjuvant chemotherapy only were independents factors associated with LRR. Combined neoadjuvant chemotherapy is superior to exclusive chemotherapy in loco-regional recurrence control after systematic therapy. These results need to be confirmed in a prospective study.