Li Junjie, Shao Zhimin, Xu Binghe, Jiang Zefei, Cui Shude, Zhang Jin, Liao Ning, Jiang Jun, Wang Yongsheng, Ouyang Quchang, Ying Ziwei
Fudan University Shanghai Cancer Center, Shanghai China Medical University, Shenyang The 307th Hospital of Chinese People's Liberation Army, Beijing Henan Province Cancer Hospital, Zhengzhou Tianjin Medical University Cancer Institute and Hospital, Tianjin Guangdong General Hospital, Guangzhou Southwest Hospital (the First Affiliated Hospital of the Third Military Medical University), Chongqing Shandong Province Cancer Prevention and Control Institute, Jinan Hunan Cancer Hospital, Changsha Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China.
Medicine (Baltimore). 2018 May;97(21):e10350. doi: 10.1097/MD.0000000000010350.
The aim of this study was to understand current trends in trastuzumab use in China as a neoadjuvant/adjuvant therapy for human epidermal growth factor receptor-2 positive (HER2+) breast cancer and identify factors influencing trastuzumab use.This was a retrospective, multicenter, cross-sectional study of patients diagnosed with HER2+ breast cancer (stage I-III), between July 2013 and June 2014, at 155 hospitals in 29 provinces/cities in China. Demographic and clinical data, including tumor characteristics and details of adjuvant/neoadjuvant therapies used, were collected. Data analysis included univariate analysis, multivariate logistic regression, and subgroup analyses.Of 4994 HER2+ patients (mean age 51.1 ± 9.9 years) included, only 29.8% received trastuzumab, with 30.5% in adjuvant therapy and 18.3% in neoadjuvant therapy. The highest rates of adjuvant trastuzumab were in Beijing (59.3%), Jiangsu (57.1%), and Ningxia (50.0%), while those of neoadjuvant trastuzumab were in Guangdong (24.8%), Beijing (14.1%), and Zhejiang (10.7%). Multivariate regression results revealed that factors associated with trastuzumab use were medical insurance cover for trastuzumab, residing locally to the hospital, more lymph node involvement, and more advanced tumor stage. Subgroup analysis revealed that patients receiving neoadjuvant therapy were likely to be younger, premenopausal and non-local, and had lymph node metastases, more advanced tumor, and progesterone receptor positive tumor.Trastuzumab use in patients with HER2+ breast cancer is relatively low in China, especially for neoadjuvant therapy. Insurance coverage seems to be the most correlated factor that influences the use of trastuzumab in Chinese patients with HER2+ breast cancer.
本研究旨在了解中国将曲妥珠单抗用作人表皮生长因子受体2阳性（HER2+）乳腺癌新辅助/辅助治疗的当前趋势，并确定影响曲妥珠单抗使用的因素。这是一项回顾性、多中心、横断面研究，研究对象为2013年7月至2014年6月期间在中国29个省/市的155家医院诊断为HER2+乳腺癌（I-III期）的患者。收集了人口统计学和临床数据，包括肿瘤特征以及所使用的辅助/新辅助治疗的详细信息。数据分析包括单因素分析、多因素逻辑回归分析和亚组分析。纳入的4994例HER2+患者（平均年龄51.1±9.9岁）中，仅29.8%接受了曲妥珠单抗治疗，其中辅助治疗占30.5%，新辅助治疗占18.3%。辅助曲妥珠单抗使用率最高的地区是北京（59.3%）、江苏（57.1%）和宁夏（50.0%），而新辅助曲妥珠单抗使用率最高的地区是广东（24.8%）、北京（14.1%）和浙江（10.7%）。多因素回归结果显示，与曲妥珠单抗使用相关的因素有曲妥珠单抗的医保覆盖、居住在医院所在地区、更多的淋巴结受累以及更晚期的肿瘤分期。亚组分析显示，接受新辅助治疗的患者可能更年轻、处于绝经前且非本地居民，有淋巴结转移、肿瘤更晚期且孕激素受体阳性。中国HER2+乳腺癌患者中曲妥珠单抗的使用率相对较低，尤其是新辅助治疗。医保覆盖似乎是影响中国HER2+乳腺癌患者使用曲妥珠单抗的最相关因素。
