Department of Radiation Oncology, University of Virginia, Charlottesville, VA.
Department of Radiation Oncology, University of Virginia, Charlottesville, VA.
Clin Breast Cancer. 2018 Apr;18(2):121-127. doi: 10.1016/j.clbc.2017.06.010. Epub 2017 Jun 29.
There is an established relationship between hormone receptor (HR; estrogen and/or progesterone receptors) status, HER2 status, and locoregional recurrence. The purpose of this study was to analyze how HR and HER2 receptor status have influenced the surgical management trends among patients with early stage breast cancer.
The National Cancer Database was queried for patients with cT1 to cT3, cN0, and cM0 breast carcinoma from 2004 to 2012. Patients were grouped on the basis of receptor status and surgical management (mastectomy or breast-conserving surgery [BCS]). Multivariable analyses were performed to investigate factors associated with increased odds of receiving mastectomy over BCS. Among a subgroup of patients who underwent ipsilateral mastectomy, analyses were performed to determine any association between contralateral prophylactic mastectomy (CPM) and receptor status.
We found 280,241 patients who met inclusion criteria for analyzing mastectomy or BCS surgical decision. Patients with HER2-positive (HER2) tumors (HR/HER and HR/HER2) were the most likely to undergo mastectomy (odds ratio [OR], 1.212 and 1.499 respectively, compared with HR/HER2 patients, each P < .001). HR status alone did not affect ipsilateral surgical management as patients with HR/HER2 and HR/HER2 tumors demonstrated similar mastectomy rates (P = .391). Among the 108,018 who underwent mastectomy, 20% underwent CPM. After adjustment, patients with HR/HER2, HR/HER2, and HR/HER2 were all more likely to undergo CPM (OR 1.356, 1.608, and 1.358, respectively compared with HR/HER2 patients, each P < .001).
This analysis indicates that patients with early stage breast cancer are more likely to undergo a mastectomy and CPM if they have HER2 tumors.
激素受体（HR；雌激素和/或孕激素受体）状态、HER2 状态与局部区域复发之间存在明确的关系。本研究的目的是分析 HR 和 HER2 受体状态如何影响早期乳腺癌患者的手术管理趋势。
从 2004 年至 2012 年，国家癌症数据库对 cT1 至 cT3、cN0 和 cM0 乳腺癌患者进行了查询。患者根据受体状态和手术管理（乳房切除术或保乳手术[BCS]）进行分组。进行多变量分析以研究与接受乳房切除术而非 BCS 的几率增加相关的因素。在接受同侧乳房切除术的亚组患者中，分析了对侧预防性乳房切除术（CPM）与受体状态之间的任何关联。
我们发现 280241 名符合分析乳房切除术或 BCS 手术决策标准的患者。HER2 阳性（HER2）肿瘤（HR/HER 和 HR/HER2）患者最有可能接受乳房切除术（比值比[OR]分别为 1.212 和 1.499，与 HR/HER2 患者相比，均 P<.001）。HR 状态本身并不影响同侧手术管理，因为 HR/HER2 和 HR/HER2 肿瘤患者的乳房切除术率相似（P=.391）。在 108018 名接受乳房切除术的患者中，20%接受了 CPM。调整后，HR/HER2、HR/HER2 和 HR/HER2 患者均更有可能接受 CPM（OR 分别为 1.356、1.608 和 1.358，与 HR/HER2 患者相比，均 P<.001）。
这项分析表明，患有早期乳腺癌且具有 HER2 肿瘤的患者更有可能接受乳房切除术和 CPM。
