Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials

作者：Bernard Asselain, William Eric Barlow, John M.S. Bartlett, Jonas C. S. Bergh, Elizabeth Bergsten-Nordström, Judith M. Bliss, Francesco Boccardo, Clare Boddington, Jan Bogaerts, Gianni Bonadonna, Rosie Bradley, Etienne G.C. Brain, Jeremy P. Braybrooke, Philippe Broët, John Bryant, Julie Ann Burrett, David Cameron, Mike J Clarke, Alan Stuart Coates, Robert Louis Coleman, Raoul Charles Coombes, Candace R. Correa, Joe Costantino, Jack M. Cuzick, David N. Danforth, Nancy E. Davidson, Christina Davies, Lucy Claire Davies, Angelo Di Leo, David John Dodwell, Mitch Dowsett, Frances K. Duane, Vaughan Evans, Marianne Ewertz, Bernard Fisher, John Forbes, Leslie G. Ford, J.-C. Gazet, Richard D. Gelber, Lucy Gettins, Luca Gianni, Michael Gnant, Jon Godwin, Aron Goldhirsch, Pamela Jean Goodwin, Richard G. Gray, Daniel F.C. Hayes, Catherine Hill, James N. Ingle, Reshma Jagsi, R. Jakesz, Sam H. James, Wolfgang J. Janni, Hui Liu, Zulian Liu, Caroline A. Lohrisch, Sibylle Loibl, Liz MacKinnon, Andreas Makris, Eleftherios P. Mamounas, Gurdeep Mannu, Miguel Martín, Simone Mathoulin, L. Mauriac, Paul McGale, Theresa W. McHugh, Philip Morris, Hirofumi Mukai, Larry Norton, Yasuo Ohashi, Ivo A. Olivotto, Soon Young Paik, Hongchao Pan, Richárd Pető, Martine J Piccart, Lori J. Pierce, Philip M. Poortmans, Trevor J. Powles, K.I. Pritchard, Joseph Ragaz, Vinod Raina, Peter M. Ravdin, Simon Read, Meredith M. Regan, John F.R. Robertson, Emiel J. Th. Rutgers, Suzy Scholl, Dennis J. Slamon, Lidija Sölkner, Joseph A. Sparano, Seth M. Steinberg, Rosemary Sutcliffe, Sandra M. Swain, Carolyn W. Taylor, Andrew N.J. Tutt, Pinuccia Valagussa, Cornelis J.�H. van de Velde, Jos A. van der Hage, Giuseppe Viale, Gϋnter von Minckwitz, Yaochen Wang, Zhe Wang, Xiang Wang, Timothy Joseph Whelan, Nicholas Wilcken, Eric P. Winer, Norman Wolmark, William Wood, Milvia Zambetti, Jo Anne Zujewski · 发表于：The Lancet Oncology · 年份：2017 · DOI：10.1016/s1470-2045(17)30777-5 · 被引用次数：1153 · 研究领域：Breast Cancer Treatment Studies、Breast Lesions and Carcinomas、Breast Implant and Reconstruction

BACKGROUND: Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. METHODS: We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). FINDINGS: Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treat...