Lee Hye Yoon, Shin In-Soo, Rim Chai Hong
Division of Breast and Endocrine Surgery, Department of Surgery, Ansan Hospital, Korea University, Gyeonggido, Republic of Korea.
Department of Education, College of Education, Dongguk University, Seoul, Republic of Korea.
Ann Transl Med. 2020 Mar;8(5):187. doi: 10.21037/atm.2020.01.81.
Although trastuzumab has been shown to be beneficial for treating patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer, information regarding its benefits is limited to very low-risk cases with tumours ≤1 cm and without lymphatic metastases (pT1abN0). The present meta-analysis integrates information from literature and determines the benefit of trastuzumab in pT1abN0, HER2-positive breast cancer patients.
PubMed, MEDLINE, and EMBASE databases were searched for studies published before Sep 30, 2019. Our primary endpoint was tumor recurrence, whether provided as overall or distant recurrences.
Seven studies involving 1,181 patients with pT1abN0, HER2-positive breast cancer were included in the systemic review. The median follow-up periods ranged from 37 to 78 months. The patients in the trastuzumab arm had generally inferior profiles such as higher rate of T1b, grade 3, and hormone negative cases, among available studies. Concomitant chemotherapy was more commonly applied in the trastuzumab arm (75-100% 0-42%), and the hormone therapy application was similar in both arms (20-66%). In a pooled analysis of seven available studies, patients treated with trastuzumab had less overall recurrence relative to controls, with an odds ratio of 0.201 [95% confidence interval (CI): 0.100-0.404, P<0.001]. Five studies were available for a pooled analysis of distant recurrence. Although the results were not significant (P=0.115), distant recurrence did not occur in 237 patients treated with trastuzumab, but did occur in 16 out of 436 control patients. The odds ratio for distant recurrence was 0.328 (95% CI: 0.082-1.311).
The adjuvant treatment including trastuzumab was shown to reduce overall recurrence. Distant recurrence may also be reduced, as it did not occur among the 237 patients who underwent trastuzumab treatment.
尽管曲妥珠单抗已被证明对治疗人表皮生长因子受体2（HER2）阳性乳腺癌患者有益，但其益处的信息仅限于肿瘤≤1 cm且无淋巴转移（pT1abN0）的极低风险病例。本荟萃分析整合了文献中的信息，并确定了曲妥珠单抗在pT1abN0、HER2阳性乳腺癌患者中的益处。
检索了PubMed、MEDLINE和EMBASE数据库中2019年9月30日前发表的研究。我们的主要终点是肿瘤复发，无论是总体复发还是远处复发。
系统评价纳入了7项研究，共1181例pT1abN0、HER2阳性乳腺癌患者。中位随访期为37至78个月。在现有研究中，曲妥珠单抗组患者的总体情况通常较差，如T1b、3级和激素阴性病例的比例较高。曲妥珠单抗组更常应用联合化疗（75 - 100%对0 - 42%），两组激素治疗的应用情况相似（20 - 66%）。在对7项现有研究的汇总分析中，接受曲妥珠单抗治疗的患者相对于对照组总体复发较少，比值比为0.201[95%置信区间（CI）：0.100 - 0.404，P<0.001]。有5项研究可用于远处复发的汇总分析。尽管结果不显著（P = 0.115），但237例接受曲妥珠单抗治疗的患者未发生远处复发，而436例对照患者中有16例发生了远处复发。远处复发的比值比为0.328（95%CI：0.082 - 1.311）。
包括曲妥珠单抗在内的辅助治疗可降低总体复发率。远处复发率也可能降低，因为在接受曲妥珠单抗治疗的237例患者中未发生远处复发。
