Villasco Andrea, Actis Silvia, Bounous Valentina Elisabetta, Borella Fulvio, D'Alonzo Marta, Ponzone Riccardo, De Sanctis Corrado, Benedetto Chiara, Biglia Nicoletta
Academic Division of Obstetrics and Gynaecology-A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy.
Gynaecology and Obstetrics 1-City of Health and Science, University of Turin, 10126 Turin, Italy.
Cancers (Basel). 2021 Nov 21;13(22):5836. doi: 10.3390/cancers13225836.
The treatment with adjuvant Trastuzumab in patients diagnosed with HER2+ small breast cancers is controversial: limited prospective data from randomized trials is available. This study aims to measure the effect of Trastuzumab in the early stages of breast cancer (pT1mic/a pN0/1mi) in terms of disease recurrence and to identify which are the factors that most affect the prognosis of small HER2+ tumors. One hundred HER2+ pT1mic-pT1a breast cancer patients who were treated in three Turin Breast Units between January 1998 and December 2018 were retrospectively selected and reviewed. Trastuzumab was administered to 23 patients. Clinicopathological features and disease-free survival (DFS) were compared between different subgroups. The primary outcome was the disease recurrence rate. Median follow-up time was 86 months. Compared to pT1a tumors, pT1mic lesions had a higher tumor grade (84% of pT1mic vs. 55% of pT1a; = 0.003), a higher Ki-67 index (81% vs. 46%; = 0.007) and were more frequently hormone receptor (HR) negative (69% vs. 36%, = 0.001). Disease recurrence rate was significantly lower among patients who received adjuvant Trastuzumab ( = 0.02), with this therapy conferring an 85% reduction in the risk of relapse (HR 0.15; = 0.02). Among the patients who did not receive adjuvant Trastuzumab, the only factor significantly associated with an increased risk of developing a recurrence was the immunohistochemical (IHC) subtype: in fact, HR- HER2+ tumors showed a risk seven times higher of relapsing (HR 7.29; = 0.003). Adjuvant Trastuzumab appears to reduce the risk of disease recurrence even in small HER2+ tumors. The adjuvant targeted therapy should be considered in patients with HR- HER2+ tumors since they have the highest risk of recurrence, independently from size and grade.
对于确诊为HER2阳性的小乳腺癌患者，使用曲妥珠单抗进行辅助治疗存在争议：随机试验的前瞻性数据有限。本研究旨在评估曲妥珠单抗在乳腺癌早期阶段（pT1mic/a pN0/1mi）对疾病复发的影响，并确定哪些因素对HER2阳性小肿瘤的预后影响最大。回顾性选取并分析了1998年1月至2018年12月期间在都灵三个乳腺科接受治疗的100例HER2阳性pT1mic-pT1a乳腺癌患者。23例患者接受了曲妥珠单抗治疗。比较了不同亚组之间的临床病理特征和无病生存期（DFS）。主要结局是疾病复发率。中位随访时间为86个月。与pT1a肿瘤相比，pT1mic病变的肿瘤分级更高（pT1mic为84%，pT1a为55%；P = 0.003），Ki-67指数更高（81%对46%；P = 0.007），且激素受体（HR）阴性更为常见（69%对36%，P = 0.001）。接受辅助曲妥珠单抗治疗的患者疾病复发率显著更低（P = 0.02），该治疗使复发风险降低了85%（HR 0.15；P = 0.02）。在未接受辅助曲妥珠单抗治疗的患者中，唯一与复发风险增加显著相关的因素是免疫组化（IHC）亚型：实际上，HR阴性HER2阳性肿瘤的复发风险高出7倍（HR 7.29；P = 0.003）。辅助曲妥珠单抗似乎能降低即使是HER2阳性小肿瘤的疾病复发风险。对于HR阴性HER2阳性肿瘤患者，应考虑辅助靶向治疗，因为他们具有最高的复发风险，与肿瘤大小和分级无关。
