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  • [J Breast Cancer.] Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy.

    이화의대 / 장지현, 김규보*

  • 출처
    J Breast Cancer.
  • 등재일
    2016 Dec
  • 저널이슈번호
    19(4):394-401. doi: 10.4048/jbc.2016.19.4.394. Epub 2016 Dec 23.
  • 내용

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    Abstract

    PURPOSE:

    In the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC).

     

    METHODS:

    Between March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/- multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12-106) months.

     

    RESULTS:

    The 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures.

     

    CONCLUSION:

    Among breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.

    Author information

    Chang JH1, Jeon W2, Kim K3, Shin KH2, Han W4, Noh DY4, Im SA5, Kim TY5, Bang YJ5.

    1Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea.
    2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
    3Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea.
    4Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
    5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

  • 키워드
    Breast neoplasms; Neoadjuvant therapy; Prognosis; Tumor location
  • 연구소개
    Neoadjuvant chemotherapy (NAC)는 유방암에서 subclinical distant metastasis의 감소, 유방보존수술 적용 가능성의 증가 등의 이점으로 쓰임이 확대되고 있다. NAC가 시행되기 이전 시기의 보고에 따르면 유방암 환자에서 inner/both quadrant의 tumor는 생존에 좋지 않은 예후인자로 생각되어왔다. 따라서 본 논문에서는 NAC를 시행한 환자에서 종양 위치가 생존에 미치는 영향을 연구하고자 하였다. 179명의 stage II/III 환자를 대상으로 분석하였으며, 분석 결과 inner/both quadrant의 환자들은 outer quadrant 에 비해 낮은 5-year DFS를 보임이 관찰되었다 (67.7% vs. 83.4%; hazard ratio [HR]=1.941, p=0.034). IMN에 대한 방사선치료는 inner/both quadrant 환자 군 중 51.1%에서 이루어졌으며, IMN RT의 시행은 비 IMN RT군에 비해서 생존에 이득을 보이지 않았다. 결과적으로 NAC의 시행 이후에도 inner/both quadrant의 breast cancer는 낮은 DFS와 연관이 있음을 본 연구를 통하여 확인할 수 있었으며, 이 환자군에 대해서는 보다 적극적인 치료가 필요할 것이다.
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