AIM This pooled analysis aimed to evaluate locoregional recurrence (LRR) rates of breast cancer (BC) after neoadjuvant chemotherapy (NACT) and to identify independent LRR predictors. METHODS 10,075 women with primary BC from nine neoadjuvant trials were included. The primary outcome was the cumulative incidence rate of LRR as the first event after NACT. Distant recurrence, secondary malignancy or death were defined as competing events. For identifying LRR predictors, surgery type, pathological complete response (pCR), BC subtypes and other potential risk factors were evaluated. RESULTS Median followup was 67 months (range 0-215), overall LRR rate was 9.5%, 4.1% in pCR versus 9.5% in non-pCR patients. Younger age, clinically positive lymph nodes, G3 tumours, non-pCR and TNBC but not surgery type were independent LRR predictors in multivariate analysis. Among BC subtypes, 5-year cumulative LRR rates were associated with higher risk in non-pCR versus pCR patients, which was significant for HR+/HER2- (5.9% vs 3.9%; HR = 2.32 [95%CI 1.22-4.43]; p = 0.011); HR-/HER2+ (14.8% vs 3.1%; HR = 4.26 [94%CI 2.35-7.71]; p < 0.001) and TNBC (18.5% vs 4.2%; HR = 4.10 [95%CI 2.88-5.82]; p < 0.001) but not for HR+/HER2+ (8.1% vs 4.8%; HR = 1.56 [95%CI 0.85-2.85]; p = 0.150). Within non-pCR subgroup, LRR risk was higher for HR-/HER2+ and TNBC vs HR+/HER2- (HR = 2.05 [95%CI 1.54-2.73]; p < 0.001 and HR = 2.77 [95%CI 2.27-3.39]; p < 0.001, respectively). CONCLUSIONS This pooled analysis demonstrated that young age, node-positive and G3 tumours, as well as TNBC, and non-pCR significantly increased the risk of LRR after NACT. Hence, there is a clear need to investigate better multimodality therapies in the post-neoadjuvant setting for high-risk patients.

中文翻译：

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新辅助化疗后的局部复发风险：九项前瞻性新辅助乳腺癌试验的汇总分析。

目的该汇总分析旨在评估新辅助化疗（NACT）后乳腺癌（BC）的局部复发率（LRR），并确定独立的LRR预测因子。方法包括来自9项新辅助试验的10,075名原发性BC妇女。主要结果是在NACT之后的第一事件LRR的累积发生率。远处复发，继发性恶性肿瘤或死亡被定义为竞争事件。为了确定LRR预测因子，对手术类型，病理完全缓解（pCR），BC亚型和其他潜在危险因素进行了评估。结果中位随访时间为67个月（范围为0-215），总体LRR率为9.5％，pCR患者为4.1％，非pCR患者为9.5％。年龄较小，临床淋巴结阳性，G3肿瘤，在多变量分析中，非pCR和TNBC但非手术类型是LRR的独立预测指标。在BC亚型中，非pCR患者相对于pCR患者的5年累积LRR率与较高风险相关，这对于HR + / HER2-显着（5.9％vs 3.9％； HR = 2.32 [95％CI 1.22-4.43]； p = 0.011）；HR- / HER2 +（14.8％vs 3.1％; HR = 4.26 [94％CI 2.35-7.71]; p <0.001）和TNBC（18.5％vs 4.2％; HR = 4.10 [95％CI 2.88-5.82]; p < 0.001），但不适用于HR + / HER2 +（8.1％对4.8％； HR = 1.56 [95％CI 0.85-2.85]； p = 0.150）。在非pCR亚组中，HR- / HER2 +和TNBC的LRR风险高于HR + / HER2-（HR = 2.05 [95％CI 1.54-2.73]； p <0.001和HR = 2.77 [95％CI 2.27-3.39] ；分别为p <0.001）。结论这项汇总分析表明，年轻人，淋巴结阳性和G3肿瘤以及TNBC，非pCR会显着增加NACT后发生LRR的风险。因此，显然有必要针对高危患者在新辅助治疗后研究更好的多模态疗法。