Division of Breast, Department of Surgery, University of Kosin College of Medicine, Kosin University Gospel Hospital, Busan, South Korea.
Division of Breast, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Asian J Surg. 2019 Oct;42(10):914-921. doi: 10.1016/j.asjsur.2019.01.003. Epub 2019 Mar 1.
BACKGROUND/OBJECTIVE: The prognosis of hormone receptor-positive and HER2-negative breast cancer is better than that of other subtypes. Current guidelines recommend chemotherapy for N1 breast cancer patients. However, this has the possibility to be over-treatment.
This was a retrospective study of 18,549 patients who were surgically treated for invasive breast cancer, at a single center in South Korea, between January 1993 and December 2012. N1 stage breast cancer patients who were hormone receptor-positive and HER2-negative were enrolled, and propensity score matching was performed to compare patients treated with anti-hormonal therapy alone (N = 83) and those treated with chemotherapy followed by anti-hormonal therapy (N = 85).
In survival analysis, the survival parameters of the endocrine therapy-only group and the chemotherapy with endocrine therapy group were respectively 96.1% and 94.0% for 5-year recurrence free survival (RFS), 89.6% and 94.0% for 10-year RFS, 97.4% and 94.0% for 5-year distant metastasis-free survival (DMFS), 93.2% and 94.0% for 10-year DMFS, 98.7% and 98.8% for 10-year breast cancer-specific survival (BCSS), and 98.7% and 98.8% for 10-year overall survival (OS). There were no significant differences in RFS (p = 0.871), DMFS (p = 0.491), BCSS (p = 0.569) and OS (p = 0.731) between the two groups.
Several patients with clinicopathologic features like hormone receptor positivity and HER2 negativity can avoid chemotherapy even with lymph node metastasis. Future studies with a long-term follow-up and a larger number of patients are required for validating our results.
背景/目的：激素受体阳性和 HER2 阴性乳腺癌的预后优于其他亚型。目前的指南建议对 N1 期乳腺癌患者进行化疗。然而，这有可能是过度治疗。
这是一项在韩国的一家单中心进行的回顾性研究，共纳入了 18549 例在 1993 年 1 月至 2012 年 12 月期间接受手术治疗的浸润性乳腺癌患者。纳入了激素受体阳性和 HER2 阴性的 N1 期乳腺癌患者，并进行了倾向评分匹配，以比较仅接受抗激素治疗的患者（N=83）和接受化疗后再接受抗激素治疗的患者（N=85）。
在生存分析中，内分泌治疗组和化疗联合内分泌治疗组的 5 年无复发生存率（RFS）分别为 96.1%和 94.0%，10 年 RFS 分别为 89.6%和 94.0%，5 年远处无复发生存率（DMFS）分别为 97.4%和 94.0%，10 年 DMFS 分别为 93.2%和 94.0%，10 年乳腺癌特异性生存率（BCSS）分别为 98.7%和 98.8%，10 年总生存率（OS）分别为 98.7%和 98.8%。两组间 RFS（p=0.871）、DMFS（p=0.491）、BCSS（p=0.569）和 OS（p=0.731）均无统计学差异。
一些具有激素受体阳性和 HER2 阴性等临床病理特征的患者即使有淋巴结转移也可以避免化疗。需要进行具有长期随访和更多患者的进一步研究来验证我们的结果。
