Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
Breast Cancer Res Treat. 2022 May;193(1):161-173. doi: 10.1007/s10549-022-06550-2. Epub 2022 Mar 3.
Although adjuvant systemic therapy (AST) helps increase breast cancer-specific survival (BCSS), there is a growing concern for overtreatment. By estimating the expected BCSS of AST using PREDICT, this study aims to quantify the number of patients treated with AST without benefit to provide estimates of overtreatment.
Data of all non-metastatic unilateral breast cancer patients diagnosed in 2015 were retrieved from cancer registries from The Netherlands and the USA. The PREDICT tool was used to estimate AST survival benefit. Overtreatment was defined as the proportion of patients that would have survived regardless of or died despite AST within 10 years. Three scenarios were evaluated: actual treatment, and recommendations by the Dutch or USA guidelines.
59.5% of Dutch patients were treated with AST. 6.4% (interquartile interval [IQI] = 2.5, 8.2%) was expected to survive at least 10 years due to AST, leaving 93.6% (IQI = 91.8, 97.5%) without AST benefit (overtreatment). The lowest expected amount of overtreatment was in the targeted and chemotherapy subgroup, with 86.5% (IQI = 83.4, 89.6%) overtreatment, and highest in the only endocrine treatment subgroup, with 96.7% (IQI = 96.0, 98.1%) overtreatment. Similar results were obtained using data from the USA, and guideline recommendations.
Based on PREDICT, AST prevents 10-year breast cancer death in 6.4% of the patients treated with AST. Consequently, AST yields no survival benefit to many treated patients. Especially improved personalization of endocrine therapy is relevant, as this therapy is widely used and is associated with the highest amount of overtreatment.
尽管辅助全身治疗（AST）有助于提高乳腺癌特异性生存（BCSS），但人们越来越担心过度治疗。本研究旨在通过使用 PREDICT 估计 AST 的预期 BCSS，从而量化接受 AST 治疗但无获益的患者数量，以提供过度治疗的估计值。
从荷兰和美国的癌症登记处检索了 2015 年诊断的所有非转移性单侧乳腺癌患者的数据。使用 PREDICT 工具估计 AST 生存获益。过度治疗定义为在 10 年内无论是否接受 AST 治疗都将存活或因 AST 而死亡的患者比例。评估了三种情况：实际治疗以及荷兰或美国指南的建议。
59.5%的荷兰患者接受了 AST 治疗。预计有 6.4%（四分位间距 [IQI] = 2.5，8.2%）的患者因 AST 至少存活 10 年，这意味着 93.6%（IQI = 91.8，97.5%）的患者未从 AST 中获益（过度治疗）。在靶向和化疗亚组中，预期过度治疗的程度最低，为 86.5%（IQI = 83.4，89.6%），在仅内分泌治疗亚组中，预期过度治疗的程度最高，为 96.7%（IQI = 96.0，98.1%）。使用来自美国的数据和指南建议也得到了类似的结果。
根据 PREDICT，AST 可预防接受 AST 治疗的患者中有 6.4%在 10 年内死于乳腺癌。因此，AST 对许多接受治疗的患者没有生存获益。特别是内分泌治疗的个体化改进具有重要意义，因为这种治疗方法广泛应用，与最高程度的过度治疗相关。
