Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China; Department of Breast Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
Breast. 2022 Jun;63:177-186. doi: 10.1016/j.breast.2022.03.015. Epub 2022 Apr 8.
Neoadjuvant therapy (NAT) is considered the standard of care for patients with HER2-positive breast cancer (BC). However, there is no proven survival benefit of NAT compared to adjuvant therapy for the survival of patients with early-stage HER2-positive BC. This study aimed to compare the prognosis of HER2-positive BC patients treated with NAT to that of patients treated with adjuvant therapy.
This was a single-center real-world retrospective study. This study analyzed the disease-free survival (DFS) and overall survival (OS) of 538 HER2-positive BC patients treated with neoadjuvant therapy and 2684 patients treated with adjuvant therapy at Fudan University Shanghai Cancer Center (FUSCC) between 2012 and 2016. Patients with a clinical tumor size (cT) ≤5 cm or >5 cm were matched using the propensity score matching (PSM) method to prevent selection bias.
After PSM, among patients with cT ≤ 5 cm, there was no significant difference in DFS (P = 0.08) or OS (P = 0.11) between the two groups. The analysis of survival outcomes of patients treated with neoadjuvant and adjuvant therapy in the different chemotherapy subgroups yielded consistent results. According to multivariate analysis, lymph node status and response to NAT showed independent prognostic value for OS and DFS. Among patients with cT > 5 cm, the DFS (P = 0.25) and OS (P = 0.57) of patients treated with NAT were similar to those of patients treated with adjuvant therapy after PSM.
We confirmed the equivalent effects of adjuvant therapy and NAT in HER2-positive BC patients. Neoadjuvant therapy should be used for patients with HER2-positive BC.
新辅助治疗（NAT）被认为是 HER2 阳性乳腺癌（BC）患者的标准治疗方法。然而，与辅助治疗相比，NAT 并未为早期 HER2 阳性 BC 患者的生存带来明显获益。本研究旨在比较接受 NAT 治疗和辅助治疗的 HER2 阳性 BC 患者的预后。
这是一项单中心真实世界回顾性研究。本研究分析了复旦大学附属肿瘤医院（FUSCC）在 2012 年至 2016 年间收治的 538 例接受新辅助治疗和 2684 例接受辅助治疗的 HER2 阳性 BC 患者的无病生存期（DFS）和总生存期（OS）。采用倾向评分匹配（PSM）方法对临床肿瘤大小（cT）≤5cm 或>5cm 的患者进行匹配，以防止选择偏倚。
PSM 后，cT≤5cm 的患者中，两组间 DFS（P=0.08）或 OS（P=0.11）均无显著差异。对接受新辅助和辅助治疗的不同化疗亚组患者的生存结果进行分析，结果一致。多因素分析显示，淋巴结状态和 NAT 反应对 OS 和 DFS 具有独立的预后价值。cT>5cm 的患者中，PSM 后，NAT 组与辅助治疗组的 DFS（P=0.25）和 OS（P=0.57）相似。
我们证实了辅助治疗和 NAT 在 HER2 阳性 BC 患者中的等效作用。NAT 应用于 HER2 阳性 BC 患者。
