Zheng Dan, Song Linlin, Liu Xu, Zhong Xiaorong, Xie Yuxin, Wang Chengshi, He Ping, Yan Xi, Tian Tinglun, Zheng Hong, Luo Ting
Laboratory of Integrative Medicine, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China.
Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
Gland Surg. 2022 May;11(5):805-817. doi: 10.21037/gs-22-229.
Trastuzumab has significantly improved the outcomes of human epidermal growth factor receptor 2 (HER2)-positive breast cancer over 20 years, and remains a cornerstone of treatment for this subtype today. Higher mortality was reported in underinsured breast cancer, but the mechanism remains unclear. Financial support for trastuzumab has transitioned from no support, to the Breast Cancer Assistant Program (BCAP), and finally, health insurance. Exploring the association between survival outcomes and different financial supports is necessary to further improve the outcomes of HER2-positive breast cancer in resource-limited regions.
A prospective cohort of primary early unilateral HER2-positive breast cancer patients registered between January 2002 and December 2020 was used. Patients were divided into the following 3 groups, based on when they were diagnosed with breast cancer: (I) before 2011 (no financial support); (II) 2011-2017 (BCAP support); and (III) 2018 onwards (health insurance support). Overall survival and invasive disease-free survival (iDFS) were the primary outcomes. The follow-up was performed according the standard procedure. Cox proportional hazards regression was used to explore the association between financial support and prognosis with adjustment of demographic and clinicopathological characteristics, and treatments.
A total of 2,972 patients were finally identified. During the median follow-up period of 3.9 years, there were 153 breast cancer-related deaths. When fully adjusted potential covariates, patients supported by the BCAP had a 37% [hazard ratio (HR): 0.63, 95% CI: 0.41-0.96] decreased risk of overall mortality and that of patients covered by health insurance had a 64% decreased of overall mortality (HR: 0.36, 95% CI: 0.17-0.74) when compared with those who did not receive any financial support. Lower overall mortality was observed in patients covered by a higher reimbursement rate (HR: 0.68, 95% CI: 0.49-0.94) or the urban scheme (HR: 0.61, 95% CI: 0.43-0.86) than those covered by a lower reimbursement rate or the rural scheme. The same trends were also observed for iDFS and breast cancer-specific survival.
Our findings revealed the independent role of financial support in improving the survival outcomes of the HER2-positive breast cancer in resource-limited regions and the underneath mechanism.
20多年来，曲妥珠单抗显著改善了人表皮生长因子受体2（HER2）阳性乳腺癌的治疗效果，至今仍是该亚型治疗的基石。据报道，保险不足的乳腺癌患者死亡率较高，但其机制尚不清楚。曲妥珠单抗的经济支持已从无支持转变为乳腺癌援助项目（BCAP），最后变为医疗保险。探索生存结果与不同经济支持之间的关联，对于进一步改善资源有限地区HER2阳性乳腺癌的治疗效果十分必要。
采用2002年1月至2020年12月登记的原发性早期单侧HER2阳性乳腺癌患者的前瞻性队列。根据乳腺癌诊断时间，将患者分为以下3组：（I）2011年之前（无经济支持）；（II）2011 - 2017年（BCAP支持）；（III）2018年及以后（医疗保险支持）。总生存和无侵袭性疾病生存（iDFS）为主要结局。按照标准程序进行随访。采用Cox比例风险回归，在调整人口统计学、临床病理特征和治疗因素后，探索经济支持与预后之间的关联。
最终共纳入2972例患者。在3.9年的中位随访期内，有153例乳腺癌相关死亡。在对潜在协变量进行充分调整后，与未接受任何经济支持的患者相比，接受BCAP支持的患者总死亡风险降低37%[风险比（HR）：0.63，95%置信区间（CI）：0.41 - 0.96]，接受医疗保险的患者总死亡风险降低64%（HR：0.36，95% CI：0.17 - 0.74）。与报销率较低或农村医保方案的患者相比，报销率较高或城市医保方案的患者总死亡率更低（HR：0.68，95% CI：0.49 - 0.94；HR：0.61，95% CI：0.43 - 0.86）。iDFS和乳腺癌特异性生存也观察到相同趋势。
我们的研究结果揭示了经济支持在改善资源有限地区HER2阳性乳腺癌生存结果中的独立作用及其潜在机制。
