在淋巴结阴性、HER2阳性乳腺癌女性患者中，根据局部治疗类型和曲妥珠单抗使用情况的局部区域复发及生存结果

Locoregional recurrence and survival outcomes by type of local therapy and trastuzumab use among women with node-negative, HER2-positive breast cancer.

作者信息

Peterson David J, Truong Pauline T, Sadek Betro T, Alexander Cheryl S, Wiksyk Bradley, Shenouda Mina, Raad Rita Abi, Taghian Alphonse G

机构信息

Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Island Centre, Victoria, BC, Canada.

出版信息

Ann Surg Oncol. 2014 Oct;21(11):3490-6. doi: 10.1245/s10434-014-3767-6. Epub 2014 May 20.

DOI:10.1245/s10434-014-3767-6

PMID:24841346

Abstract

BACKGROUND

While human epidermal growth factor receptor 2 (HER2) overexpression is an adverse breast cancer prognostic factor, it is unclear whether there are differences in outcomes between types of local treatment in this population. This retrospective study examined locoregional recurrence and survival in women with node-negative, HER2+ breast cancer treated with breast-conserving therapy (BCT) versus mastectomy.

METHODS

Subjects were 748 patients with pT1-2, N0, M0 HER2+ breast cancer, treated with BCT (n = 422) or mastectomy (n = 326). Trastuzumab was used in 54 % of subjects. The 5-year Kaplan-Meier locoregional recurrence free survival (LRRFS), breast cancer specific survival (BCSS), and overall survival (OS) were compared between cohorts treated with BCT versus mastectomy. Subgroup analyses of LRR and survival were performed separately among patients treated with BCT or mastectomy to examine the effect of trastuzumab on outcomes in each group.

RESULTS

Median follow-up was 4.4 years. Patients treated with mastectomy had higher proportions of grade 3 histology (69 vs 60 %, p = 0.004) and lower rates of hormone therapy (51 vs 64 %, p < 0.001) and trastuzumab therapy (50 vs 57 %, p = 0.04). The 5-year outcomes in women treated with BCT compared with mastectomy were: LRRFS 98.0 versus 98.3 % (p = 0.88), BCSS 97.2 versus 96.1 % (p = 0.70), and OS 95.5 versus 93.4 % (p = 0.19). Trastuzumab was associated with similar LRRFS and improved OS in both local treatment groups.

CONCLUSIONS

BCT is safe in the population of women with pT1-2, N0, HER2+ breast cancer, providing high rates of locoregional control and survival equivalent to mastectomy. Trastuzumab was associated with improved survival in both groups.

摘要

背景

虽然人表皮生长因子受体2（HER2）过表达是乳腺癌的不良预后因素，但尚不清楚该人群中不同类型局部治疗的预后是否存在差异。这项回顾性研究比较了保乳治疗（BCT）与乳房切除术治疗的HER2阳性、腋窝淋巴结阴性乳腺癌女性的局部区域复发情况和生存率。

方法

研究对象为748例pT1-2、N0、M0期HER2阳性乳腺癌患者，其中422例接受保乳治疗，326例接受乳房切除术。54%的患者使用了曲妥珠单抗。比较保乳治疗组和乳房切除组的5年无局部区域复发生存率（LRRFS）、乳腺癌特异性生存率（BCSS）和总生存率（OS）。分别对接受保乳治疗或乳房切除术的患者进行局部区域复发和生存的亚组分析，以检验曲妥珠单抗对每组预后的影响。

结果

中位随访时间为4.4年。接受乳房切除术的患者3级组织学比例更高（69%对60%，p = 0.004），激素治疗率更低（51%对64%，p < 0.001），曲妥珠单抗治疗率更低（50%对57%，p = 0.04）。保乳治疗组与乳房切除组女性的5年预后情况如下：LRRFS分别为98.0%和98.3%（p = 0.88），BCSS分别为97.2%和96.1%（p = 0.70），OS分别为95.5%和93.4%（p = 0.19）。曲妥珠单抗在两个局部治疗组中均与相似的LRRFS和改善的OS相关。