化疗相对剂量强度对 I-III 期乳腺癌（ER+/PR+、HER2- 与三阴性）的特定病因和总生存的影响。

Impact of chemotherapy relative dose intensity on cause-specific and overall survival for stage I-III breast cancer: ER+/PR+, HER2- vs. triple-negative.

机构信息

Epidemiology program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.

Biostatistics program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.

出版信息

Breast Cancer Res Treat. 2018 May;169(1):175-187. doi: 10.1007/s10549-017-4646-1. Epub 2018 Jan 24.

DOI:10.1007/s10549-017-4646-1

PMID:29368311

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6190707/

Abstract

PURPOSE

To investigate the impact of chemotherapy relative dose intensity (RDI) on cause-specific and overall survival for stage I-III breast cancer: estrogen receptor or progesterone receptor positive, human epidermal-growth factor receptor negative (ER+/PR+ and HER2-) vs. triple-negative (TNBC) and to identify the optimal RDI cut-off points in these two patient populations.

METHODS

Data were collected by the Louisiana Tumor Registry for two CDC-funded projects. Women diagnosed with stage I-III ER+/PR+, HER2- breast cancer, or TNBC in 2011 with complete information on RDI were included. Five RDI cut-off points (95, 90, 85, 80, and 75%) were evaluated on cause-specific and overall survival, adjusting for multiple demographic variables, tumor characteristics, comorbidity, use of granulocyte-growth factor/cytokines, chemotherapy delay, chemotherapy regimens, and use of hormone therapy. Cox proportional hazards models and Kaplan-Meier survival curves were estimated and adjusted by stabilized inverse probability treatment weighting (IPTW) of propensity score.

RESULTS

Of 494 ER+/PR+, HER2- patients and 180 TNBC patients, RDI < 85% accounted for 30.4 and 27.8%, respectively. Among ER+/PR+, HER2- patients, 85% was the only cut-off point at which the low RDI was significantly associated with worse overall survival (HR = 1.93; 95% CI 1.09-3.40). Among TNBC patients, 75% was the cut-off point at which the high RDI was associated with better cause-specific (HR = 2.64; 95% CI 1.09, 6.38) and overall survival (HR = 2.39; 95% CI 1.04-5.51).

CONCLUSIONS

Higher RDI of chemotherapy is associated with better survival for ER+/PR+, HER2- patients and TNBC patients. To optimize survival benefits, RDI should be maintained ≥ 85% in ER+/PR+, HER2- patients, and ≥ 75% in TNBC patients.

摘要

目的

研究化疗相对剂量强度（RDI）对 I-III 期乳腺癌患者的特定原因和总体生存率的影响：雌激素受体或孕激素受体阳性，人表皮生长因子受体阴性（ER+/PR+ 和 HER2-）与三阴性（TNBC），并确定这两种患者人群的最佳 RDI 截止点。

方法

数据由路易斯安那肿瘤登记处为两项疾病预防控制中心资助的项目收集。纳入 2011 年诊断为 I-III 期 ER+/PR+、HER2- 乳腺癌或 TNBC 的女性，且 RDI 信息完整。评估了 5 个 RDI 截止点（95%、90%、85%、80%和 75%）对特定原因和总体生存率的影响，调整了多个人口统计学变量、肿瘤特征、合并症、使用粒细胞集落刺激因子/细胞因子、化疗延迟、化疗方案和激素治疗。使用协方差比例风险模型和 Kaplan-Meier 生存曲线进行估计，并通过稳定的逆概率治疗加权（IPTW）对倾向评分进行调整。

结果

在 494 名 ER+/PR+、HER2- 患者和 180 名 TNBC 患者中，RDI<85%分别占 30.4%和 27.8%。在 ER+/PR+、HER2- 患者中，只有 85%是低 RDI 与总体生存率较差显著相关的唯一截止点（HR=1.93；95%CI 1.09-3.40）。在 TNBC 患者中，75%是高 RDI 与特定原因生存率（HR=2.64；95%CI 1.09-6.38）和总体生存率（HR=2.39；95%CI 1.04-5.51）更好相关的截止点。