Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
Cancer Chemother Pharmacol. 2010 Aug;66(3):507-16. doi: 10.1007/s00280-009-1190-7. Epub 2009 Dec 3.
The primary aim of this study was to compare the relapse patterns of estrogen receptor (ER)-positive and ER-negative patients with HER2-overexpressing breast cancer. A secondary aim was to distinguish the preferential primary site of metastases in HER2-overexpressing breast cancer.
Out of 886 patients treated for metastatic breast cancer (MBC) between January 1995 and December 2006, 269 patients with HER2-positive tumors were identified. Of these, 198 patients with relapsed breast cancer following surgery were included in this study. Rates and patterns of relapse and metastatic spread in HER2+/ER+ and HER2+/ER- patients were analyzed. This analysis was evaluated by the validation patients' cohort of our institute prospectively.
Median relapse-free survival was longer in the HER2+/ER+ group than in the HER2+/ER- group (32.0 vs. 19.5 months, p = 0.0012). The peak of recurrence occurred at 12 months after surgery in the HER2+/ER- patients. The peak of relapse was later and the level was lower in the HER2+/ER+ patients (66 and 78 months following surgery) than in the HER2+/ER- patients (33 and 39 months following surgery, respectively). This result was reproduced by the validation cohort with great similarity. Young age [hazard ratio (HR) 1.59, p = 0.002], TNM stage 3 (HR 1.51, p = 0.005), and ER-negativity (HR 1.68, p < 0.0001) were identified as independent risk factors for relapse. Severe bone metastasis (HR 4.48, p = 0.028) and massive hepatic metastasis (HR 5.24, p = 0.043) were identified as independent risk factors for early relapse.
Our study shows that HER2-overexpressing breast cancer displays characteristic patterns of relapse and metastatic spread depending on ER status.
本研究的主要目的是比较雌激素受体（ER）阳性和 ER 阴性的人表皮生长因子受体 2（HER2）过表达型乳腺癌患者的复发模式。次要目的是区分 HER2 过表达型乳腺癌中转移的首选原发部位。
在 1995 年 1 月至 2006 年 12 月期间接受转移性乳腺癌（MBC）治疗的 886 例患者中，确定了 269 例 HER2 阳性肿瘤患者。其中，198 例手术后复发的乳腺癌患者纳入本研究。分析 HER2+/ER+和 HER2+/ER-患者的复发和转移扩散模式和发生率。该分析由我院前瞻性纳入的验证患者队列进行评估。
HER2+/ER+组的无复发生存期长于 HER2+/ER-组（32.0 个月比 19.5 个月，p=0.0012）。HER2+/ER-患者的复发高峰出现在手术后 12 个月，HER2+/ER+患者的复发高峰较晚，水平较低（手术后 66 和 78 个月），HER2+/ER-患者的复发高峰出现在手术后 33 和 39 个月。验证队列的结果具有高度相似性。年轻年龄（风险比 [HR] 1.59，p=0.002）、TNM 分期 3 期（HR 1.51，p=0.005）和 ER 阴性（HR 1.68，p<0.0001）被确定为复发的独立危险因素。严重骨转移（HR 4.48，p=0.028）和大量肝转移（HR 5.24，p=0.043）被确定为早期复发的独立危险因素。
本研究表明，HER2 过表达型乳腺癌的复发和转移扩散模式取决于 ER 状态，具有特征性。
