人表皮生长因子受体 2 阳性导管原位癌患者后续原位和浸润性乳腺癌的风险。

Risk of subsequent in situ and invasive breast cancer in human epidermal growth factor receptor 2-positive ductal carcinoma in situ.

机构信息

Division of Experimental Therapeutics.

Division of Epidemiology and Biostatistics.

出版信息

Ann Oncol. 2015 Apr;26(4):682-687. doi: 10.1093/annonc/mdv013. Epub 2015 Jan 18.

DOI:10.1093/annonc/mdv013

PMID:25600567

Abstract

BACKGROUND

To assess the prognostic role of human epidermal growth factor receptor 2 (HER2) overexpression in patients with ductal carcinoma in situ (DCIS).

PATIENTS AND METHODS

We identified patients with HER2-positive DCIS among a population of 1667 cases, prospectively diagnosed and surgically treated at the European Institute of Oncology from 1996 to 2008. Rates of subsequent DCIS or invasive cancer in HER2-positive disease were estimated. We evaluated Cumulative Incidence of In Situ Breast Cancer Recurrence (isBCR), INvasive Breast Cancer Recurrence (IBCR) and any Breast Cancer Recurrence (BCR). isBCR, IBCR and BCR were defined as the time from surgery to breast cancer recurrence as first event (in situ, invasive or both, respectively) or last visit in case of no events.

RESULTS

We identified 560 (33.5%) patients with HER2-positive DCIS. The median follow-up was 7.6 years (interquartile range 5.9-9.5). We observed 422 events out of 1667 patients, with 141 in situ recurrences, 201 invasive recurrences and 80 other events (64 second primaries and 16 deaths). The 10-year isBCR proportions were 11.8% [95% confidence interval (CI) 9.0% to 15.4%] in the HER2-positive group and 8.8% (95% CI 6.9% to 11.0%) in the HER2-negative group (Gray test, P = 0.010). At multivariable analysis, the adjusted risk of isBCR was higher in the HER2-positive group than in the HER2-negative group [hazard ratio (HR) HER2 positive versus negative: 1.59 (95% CI 1.06-2.39)]. We observed significant differences both in BCR and isBCR for patients treated by quadrantectomy without radiotherapy versus patients treated with radiotherapy [adjusted HR HER2 positive versus negative: 1.53 (95% CI 1.07-2.18) and adjusted HR HER2 positive versus negative: 2.18 (95% CI 2.18-3.69), respectively].

CONCLUSION

HER2 overexpression predicts an increased risk of isBCR. Radiotherapy reduces local failure rates in HER2-positive DCIS.

摘要

背景

评估人表皮生长因子受体 2（HER2）过表达在导管原位癌（DCIS）患者中的预后作用。

患者和方法

我们在 1996 年至 2008 年期间，从欧洲肿瘤研究所前瞻性诊断和手术治疗的 1667 例患者中确定了 HER2 阳性 DCIS 患者。估计了 HER2 阳性疾病中随后发生的 DCIS 或浸润性癌的发生率。我们评估了原位乳腺癌复发累积发生率（isBCR）、浸润性乳腺癌复发累积发生率（IBCR）和任何乳腺癌复发（BCR）。isBCR、IBCR 和 BCR 定义为从手术到首次发生乳腺癌复发（分别为原位、浸润性或两者均有）或无事件时的最后一次就诊的时间。

结果

我们确定了 560 例（33.5%）HER2 阳性 DCIS 患者。中位随访时间为 7.6 年（四分位间距 5.9-9.5）。我们观察到 1667 例患者中有 422 例出现了复发事件，其中 141 例为原位复发，201 例为浸润性复发，80 例为其他事件（64 例为第二原发性肿瘤，16 例为死亡）。HER2 阳性组的 10 年 isBCR 比例为 11.8%（95%CI 9.0%至 15.4%），HER2 阴性组为 8.8%（95%CI 6.9%至 11.0%）（灰色检验，P=0.010）。多变量分析显示，与 HER2 阴性组相比，HER2 阳性组的 isBCR 风险更高[HER2 阳性与阴性的危险比（HR）：1.59（95%CI 1.06-2.39）]。我们观察到，对于未接受放疗的象限切除术治疗的患者与接受放疗的患者，BCR 和 isBCR 均有显著差异[HER2 阳性与阴性的调整 HR：1.53（95%CI 1.07-2.18）和调整 HR：2.18（95%CI 2.18-3.69）]。