Kast Karin, Schoffer Olaf, Link Theresa, Forberger Almuth, Petzold Andrea, Niedostatek Antje, Werner Carmen, Klug Stefanie J, Werner Andreas, Gatzweiler Axel, Richter Barbara, Baretton Gustavo, Wimberger Pauline
Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
Arch Gynecol Obstet. 2017 Aug;296(2):303-312. doi: 10.1007/s00404-017-4421-x. Epub 2017 Jun 14.
Prognosis of Her2-positive breast cancer has changed since the introduction of trastuzumab for treatment in metastatic and early breast cancer. It was described to be even better compared to prognosis of Her2-negative metastatic breast cancer. The purpose of this study was to evaluate the effect of trastuzumab in our cohort. Besides the effect of adjuvant pretreatment with trastuzumab on survival of patients with metastatic Her2-positive breast cancer was analyzed.
All patients with primary breast cancer of the Regional Breast Cancer Center Dresden diagnosed during the years 2001-2013 were analyzed for treatment with or without trastuzumab in the adjuvant and in the metastatic treatment setting using Kaplan-Meier survival estimation and Cox regression. Age and tumor stage at time of first diagnosis of breast cancer as well as hormone receptor status, grading, time, and site of metastasis at first diagnosis of distant metastatic disease were analyzed.
Of 4.481 female patients with primary breast cancer, 643 presented with metastatic disease. Her2-positive status was documented in 465 patients, including 116 patients with primary or secondary metastases. Median survival of patients with Her2-positive primary metastatic disease was 3.0 years (95% CI 2.3-4.0). After adjustment for other factors, survival was better in patients with Her2-positive breast cancer with trastuzumab therapy compared to Her2-negative metastatic disease (HR 2.10; 95% CI 1.58-2.79). Analysis of influence of adjuvant therapy with and without trastuzumab by Kaplan-Meier showed a trend for better survival in not pretreated patients. Median survival was highest in hormone receptor-positive Her2-positive (triple-positive) primary metastatic breast cancer patients with 3.3 years (95% CI 2.3-4.6).
Prognosis of patients with Her2-positive metastatic breast cancer after trastuzumab treatment is more favorable than for Her2-negative breast cancer. The role of adjuvant chemotherapy with or without trastuzumab warrants further research. Survival is best in triple-positive metastatic breast cancer. This will effect counseling at the time of first diagnosis of metastatic breast cancer.
自曲妥珠单抗被用于转移性和早期乳腺癌的治疗以来，人表皮生长因子受体2（Her2）阳性乳腺癌的预后发生了变化。据描述，其预后甚至比Her2阴性转移性乳腺癌更好。本研究的目的是评估曲妥珠单抗在我们队列中的疗效。此外，还分析了曲妥珠单抗辅助预处理对转移性Her2阳性乳腺癌患者生存的影响。
对2001年至2013年期间在德累斯顿地区乳腺癌中心诊断为原发性乳腺癌的所有患者，采用Kaplan-Meier生存估计和Cox回归分析其在辅助治疗和转移性治疗中接受或未接受曲妥珠单抗治疗的情况。分析了首次诊断乳腺癌时的年龄和肿瘤分期，以及首次诊断远处转移性疾病时的激素受体状态、分级、转移时间和部位。
在4481例原发性乳腺癌女性患者中，643例出现转移性疾病。465例患者记录为Her2阳性状态，其中包括116例原发性或继发性转移患者。Her2阳性原发性转移性疾病患者的中位生存期为3.0年（95%可信区间2.3 - 4.0）。在对其他因素进行调整后，与Her2阴性转移性疾病相比，接受曲妥珠单抗治疗的Her2阳性乳腺癌患者的生存期更好（风险比2.10；95%可信区间1.58 - 2.79）。通过Kaplan-Meier分析辅助治疗使用和未使用曲妥珠单抗的影响，结果显示未接受预处理的患者有生存期更好的趋势。激素受体阳性Her2阳性（三阳性）原发性转移性乳腺癌患者的中位生存期最高，为3.3年（95%可信区间2.3 - 4.6）。
曲妥珠单抗治疗后，Her2阳性转移性乳腺癌患者的预后比Her2阴性乳腺癌患者更有利。辅助化疗联合或不联合曲妥珠单抗的作用值得进一步研究。三阳性转移性乳腺癌患者的生存期最佳。这将影响转移性乳腺癌首次诊断时的咨询。
