曲妥珠单抗时代前后HER2阳性乳腺癌新辅助化疗后的病理完全缓解及预后：来自真实队列的结果

Pathological complete response and prognosis after neoadjuvant chemotherapy for HER2-positive breast cancers before and after trastuzumab era: results from a real-life cohort.

作者信息

Hamy Anne-Sophie, Belin Lisa, Bonsang-Kitzis Hélène, Paquet Caroline, Pierga Jean-Yves, Lerebours Florence, Cottu Paul, Rouzier Roman, Savignoni Alexia, Lae Marick, Reyal Fabien

机构信息

Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), F-75248, Paris, France.

Biostatistics Department, Institut Curie, Paris 75005, France.

出版信息

Br J Cancer. 2016 Jan 12;114(1):44-52. doi: 10.1038/bjc.2015.426. Epub 2015 Dec 10.

DOI:10.1038/bjc.2015.426

PMID:26657653

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4716543/

Abstract

BACKGROUND

Trastuzumab was introduced a decade ago and has improved outcomes for HER2-positive breast cancer. We investigated the factors predictive of pathological complete response (pCR), prognostic factors for disease-free survival (DFS), and interactions between pCR and DFS after neoadjuvant treatment.

METHODS

We identified 287 patients with primary HER2-positive breast cancers given neoadjuvant chemotherapy (NAC) between 2002 and 2011. Univariate and multivariate analyses of clinical and pathological factors associated with pCR and DFS were performed.

RESULTS

pCR rates differed between patients receiving neoadjuvant trastuzumab treatment or not (47.7% versus 19.3%, P<0.0001). DFS also differed significantly between patients receiving adjuvant trastuzumab or not (hazard ratio=4.84, 95% CI (2.52; 9.31), P<0.001). We analysed 199 patients given neoadjuvant and adjuvant trastuzumab. Multivariate analysis identified older age and hormone receptor-negative tumours as independent predictors of pCR. T stage (hazard ratio=2.55, 95% CI (1.01; 6.48), P=0.05) and strict pCR (hazard ratio=9.15, 95% CI (1.22; 68.83), P=0.03) were independent predictors of DFS. The latter association was significant in the HR-negative subgroup (P=0.02) but not in the HR-positive subgroup (P=0.12).

CONCLUSIONS

Major pCR and DFS gains in HER2-positive BC were observed since 'trastuzumab' era. Further improvements rely on the enrollment of accurately selected patients into clinical trials.

摘要

背景

曲妥珠单抗于十年前问世，改善了HER2阳性乳腺癌的治疗效果。我们研究了新辅助治疗后病理完全缓解（pCR）的预测因素、无病生存（DFS）的预后因素以及pCR与DFS之间的相互作用。

方法

我们纳入了2002年至2011年间接受新辅助化疗（NAC）的287例原发性HER2阳性乳腺癌患者。对与pCR和DFS相关的临床和病理因素进行单因素和多因素分析。

结果

接受新辅助曲妥珠单抗治疗和未接受该治疗的患者pCR率有所不同（47.7%对19.3%，P<0.0001）。接受辅助曲妥珠单抗治疗和未接受该治疗的患者DFS也有显著差异（风险比=4.84，95%可信区间（2.52；9.31），P<0.001）。我们分析了199例接受新辅助和辅助曲妥珠单抗治疗的患者。多因素分析确定年龄较大和激素受体阴性肿瘤是pCR的独立预测因素。T分期（风险比=2.55，95%可信区间（1.01；6.48），P=0.05）和严格pCR（风险比=9.15，95%可信区间（1.22；68.83），P=0.03）是DFS的独立预测因素。后一种关联在HR阴性亚组中显著（P=0.02），而在HR阳性亚组中不显著（P=0.12）。