Üçlü Negatif Meme Kanseri Hastalarında Lokal ve Bölgesel Rekürrenssiz Sağkalıma Etki Eden Faktörler: Tek Merkez Deneyimi

Abstract

Üçlü negatif meme kanserinde (ÜNMK) hastalık erken evrede tespit edilse de, hastalıksız sağkalım (HSK) ve sağkalım, ÜNMK olmayanlara göre daha düşüktür ve lokal nüks/ uzak metastaz daha erken ortaya çıkma eğilimindedir. Lokal ileri ÜNMK hastalarında neoadjuvan tedavi (NKT) öncelikle tercih edilmektedir. NKT ve tedaviye patolojik tam yanıt (pCR) ise HSK artırmaktadır. Bu çalışma Uludağ Üniversitesi Tıp Fakültesi Meme Cerrahi Kliniğinde ÜNMK tanısı ile ameliyat edilen hastaların lokal ve bölgesel rekürrens (LBR) oranlarına ve rekürrenssiz sağkalımına (LBRSK) etki eden faktörlerini ortaya konulması amaçlanmıştır. 2007-2020 yılları arasında ameliyat edilen hastaların demografik, klinik, patolojik verileri ve sağkalım oranları retrospektif olarak analiz edildi. İstatistiksel analizler SPSS v23 istatistik programı kullanılarak yapıldı. 173 hastanın 83’ü (%47,7) premenopozal ve yaş ortalaması 49,36+12,29 yıldı. Hastaların 106’sı (%63,8) lokal evre, 59’u (%34,1) lokal ileri evre ve 8’i (%4,6) metastatikti. 101 (%58,4) hastaya neoadjuvant, 69 (%40) hastaya adjuvant kemoterapi verildi. 122 (%70,5) hastaya meme koruyucu cerrahi, 99 (%57,2) hastaya sentinel lenf nodu örneklemesi yapıldı. Genel takip süresi ortanca değeri 57,5 ay içerisinde, 34 (%19,7) hasta yaşamını yitirdi. Ortanca rekürrens zamanı 33 ay içerisinde ise 16 (%11,8) hastada lokal nüks, 39 (%26,6) hastada sistemik nüks izlendi. 3-yıllık LBRSK oranı %47,3 izlendi. ÜNMK’de lokal ve sistemik nüks varlığında LBRSK oranları adjuvant ve neoadjuvant tedavide benzer izlenmiştir. NKT sonrası lokal ve rejyonel rekürrensi artıran ve rekürrenssiz sağkalımı azaltan en önemli faktör N3 hastalık ve premenopozal durum olarak izlenmiştir.

Keywords

• Üçlü negatif meme kanseri
• neoadjuvan tedavi
• patolojik tam yanıt
• lokal rekürrens.
• Triple negative breast cancer
• neoadjuvant therapy
• pathological complete response
• local recurrence

Factors Affecting Local and Regional Recurrence-Free Survival in Triple Negative Breast Cancer Patients: A Single Center Experience

Abstract

Although the disease is detected at an early stage in patients with triple negative breast cancer (TNBC), the disease-free survival (DFS) and survival rates are lower than those without TNBC, and local recurrence or distant metastasis tends to occur earlier. Neoadjuvant therapy (NCT) is primarily preferred for patients with locally advanced TNBC. NCT and the pathological complete response (pCR) to treatment increase the DFS rate. This study aims to reveal the factors affecting local and regional recurrence-free survival (LRRFS) rate of patients operated on with the diagnosis of TNBC in the Breast Surgery Clinic of Uludağ University Faculty of Medicine. The demographic, clinical, and pathological data and survival rates of patients operated on between 2007 and 2020 were analyzed retrospectively. Statistical analyses were performed using the SPSS version 23 statistical software program. Eight-three (47.7%) of the 173 patients who participated in the study were premenopausal and the mean age of the patients was 49.36+12.29 years. One hundred six (63.8%) of the patients were at the local stage, 59 (34.1%) were at the local advanced stage and 8 (4.6%) were metastatic. Neoadjuvant chemotherapy was given to 101 (58.4%) patients and adjuvant chemotherapy was given to 69 (40%) patients. One hundred twenty-two (70.5%) patients underwent breast-sparing surgery, and 99 (57.2%) patients underwent sentinel lymph node sampling. The median value of the overall follow-up period was 57.5 months, and 34 (19.7%) patients lost their lives. In the median recurrence time of 33 months, 16 (11.8%) patients had local recurrence and 39 (26.6%) patients had systemic recurrence. The three-year LRDFS rate was observed as 47.3%. The LRDFS rates were similar after the adjuvant and neoadjuvant treatments in the presence of local and systemic recurrence of TNBC. The most important factors that increased local and regional recurrence after NCT and reduced recurrence-free survival were N3 disease and premenopausal status.

Keywords

• Triple negative breast cancer
• neoadjuvant therapy
• pathological complete response
• local recurrence

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