국소 진행성 유방암의 유도항암요법

Abstract

Purpose : The definition of locally advanced breast cancer (LABC) includes stage Ⅲ breast cancer. In order to investigate the factors influencing on the final outcome we analysed the data of LABC patients that received neoadjuvant chemotherapy prior to definitive surgery. Methods : 122 LABC patients, who underwent neoadjuvant chemotherapy between 1980 and 1997, were included for the analysis. Clinical responses to neoadjuvant chemotherapy were classified as complete response (CR), partial response (PR), and no response (NR). Overall survival (OS), Loco-regional relapes free survival (LRRFS), and distant relapse free survival (DRRFS) probabilities were investigated according to initial clinical stage, clinical response to neoadjuvant chemotherapy, and pathologic stage after neoadjuvant chemotherapy. Statistical analyses were performed with χ²-test, Kaplan-Meier, and Cox-regression methods using SPSS. Results : The mean age at diagnosis was 47 years old (range 31 ~ 73) and median follow-up period was 61.6 months (range 3 ~ 227 months). Among 122 LABC patients, 69 (56.6%) were included in stage ⅢA, 37 (30.3%) in stage ⅢB, and 16 (13.1%) in ⅢC at diagnosis. 10 patients (8.2%) have shown CR, 85 (69.7%) patients PR, and the remaining 27 (22.1%) patients showed NR. The overall response rate to neoadjuvant chemotherapy was 77.5%. However, only 51 (41.8%) were demonstrated to have pathologically downstaged results. There were 32 loco-regional recurrences and 59 distant metastases. All of the initial clinical stage, clinical response to neoadjuvant chemotherapy, and pathologic stage influenced the final outcome of 10 year OS, LRRFS, DRFS. However, in multivariate analysis pathologic stage after neoadjuvant chemotherapy was the most influencing factor on the final outcome. Conclusion : Pathologic stage after neoadjuvant chemotherapy could be the most important prognostic factor of the LABC.