Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2012 Oct 15;118(20):4936-43. doi: 10.1002/cncr.27502. Epub 2012 Apr 17.
Previous studies have shown that hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status influence the outcome of locoregional treatments. However, the interrelationship of these factors with trastuzumab is unclear. In this study, the role of HR and HER2 status on the locoregional benefit of trastuzumab treatment was investigated in patients with nonmetastatic breast cancer.
Locoregional outcomes of 5683 women treated at The University of Texas MD Anderson Cancer Center from 2000 to 2008 for invasive breast cancer were analyzed using Kaplan-Meier and Cox regression methods to compare 6 subgroups: HR-positive (HR+)/HER2-negative (HER2-), HR-/HER2- (triple-negative), HR+/HER2+ with or without trastuzumab, and HR-/HER2+ with or without trastuzumab.
Overall, locoregional recurrence (LRR) was 5% at 5 years among patients with HER2+ disease. Patients with HR+/HER2+ disease treated with trastuzumab had half the rate of LRR as patients who did not receive trastuzumab, whereas patients with HR-/HER2+ disease had similar rates of LRR regardless of trastuzumab treatment. On Cox regression analysis comparing LRR risk to the cohort with HR+/HER2- disease, only the HR+/HER2+ cohort treated with trastuzumab had similar LRR risk (hazard ratio = 1.24, 95% confidence interval = 0.56-2.73, P = .591). All other subgroups, including the HR+/HER2+ cohort who did not receive trastuzumab, had significantly worse outcomes. LRR risk was highest among patients with triple-negative disease (hazard ratio = 4.73, 95% confidence interval = 3.42-6.54, P < .001).
Among patients with HR+/HER2+ disease, treatment with trastuzumab reduces LRR risk to the more favorable outcome of patients with HR+/HER2- disease. In contrast, the increased LRR risk among patients with HR-/HER2+ disease remains despite treatment with trastuzumab. Additional locoregional strategies are needed in this subgroup of patients.
先前的研究表明，激素受体（HR）和人表皮生长因子受体 2（HER2）状态影响局部区域治疗的结果。然而，这些因素与曲妥珠单抗的相互关系尚不清楚。在这项研究中，我们调查了 HR 和 HER2 状态对非转移性乳腺癌患者曲妥珠单抗治疗局部区域获益的影响。
利用 Kaplan-Meier 和 Cox 回归方法分析了 2000 年至 2008 年在德克萨斯大学 MD 安德森癌症中心接受浸润性乳腺癌治疗的 5683 名女性的局部区域结果，以比较 6 个亚组：HR 阳性（HR+）/HER2 阴性（HER2-）、HR-/HER2-（三阴性）、HR+/HER2+伴或不伴曲妥珠单抗、HR-/HER2+伴或不伴曲妥珠单抗。
总体而言，HER2+疾病患者 5 年时局部区域复发（LRR）率为 5%。接受曲妥珠单抗治疗的 HR+/HER2+疾病患者的 LRR 率是未接受曲妥珠单抗治疗的患者的一半，而 HR-/HER2+疾病患者无论是否接受曲妥珠单抗治疗，LRR 率相似。在比较 HR+/HER2-疾病队列的 LRR 风险的 Cox 回归分析中，仅接受曲妥珠单抗治疗的 HR+/HER2+队列具有相似的 LRR 风险（危险比=1.24，95%置信区间=0.56-2.73，P=0.591）。所有其他亚组，包括未接受曲妥珠单抗治疗的 HR+/HER2+队列，结局均显著更差。三阴性疾病患者的 LRR 风险最高（危险比=4.73，95%置信区间=3.42-6.54，P<0.001）。
在 HR+/HER2+疾病患者中，曲妥珠单抗治疗可降低 LRR 风险，使其结局类似于 HR+/HER2-疾病患者。相比之下，HR-/HER2+疾病患者尽管接受了曲妥珠单抗治疗，LRR 风险仍增加。该亚组患者需要额外的局部区域治疗策略。
