Department of Breast Surgery, Shanxi Provincial People's Hospital, Taiyuan Shanxi China.
Department of Pathology, Shanxi Provincial People's Hospital, Taiyuan Shanxi China.
Medicine (Baltimore). 2022 Jun 24;101(25):e29371. doi: 10.1097/MD.0000000000029371.
Deciding if patients with small (≤1 cm), node-negative, human epidermal growth factor receptor 2 (HER2) positive breast cancer should receive adjuvant systemic therapy remains a challenge. No randomized clinical trials have examined the efficacy of trastuzumab in this setting. This prospective observational study aimed to investigate the choice of adjuvant systemic therapy in clinical practice in China.We prospectively collected data from patients with HER-2 positive breast cancer (less than 1 cm and node negative) patients who underwent breast cancer surgery at Shanxi Provincial People's Hospital Breast Center from January 1, 2017 to December 31, 2019, and retrospectively investigated the association between baseline clinicopathological features and treatment strategy, cardiotoxicity, and disease outcome.Of 168 eligible patients, 102 (60.7%) received adjuvant systemic therapy with trastuzumab (AST+T), 47 (28%) received adjuvant systemic therapy without trastuzumab (AST) and 19 (11.3%) did not receive adjuvant systemic therapy. Multivariate logistic regression analysis demonstrated that age, tumor size and hormone receptor status were significantly associated with treatment choice. Three-year invasive disease-free survival probability was 100%, 97.9% and 89.5% with AST+T, AST, and no therapy, respectively (P < .001).The majority of patients (60.7%) with pT1a-b pN0 HER2 positive breast cancer received adjuvant systemic therapy with trastuzumab, whereas only 11.3% did not receive any adjuvant systemic therapy. Tumor size, age and hormone receptor status influenced treatment choice. The 3-year invasive disease-free survival probability was significantly higher for patients who received adjuvant systemic therapy with trastuzumab compared with those who did not receive adjuvant systemic therapy. Cardiac adverse events were rare.
对于直径≤1cm、淋巴结阴性、人表皮生长因子受体 2（HER2）阳性的乳腺癌患者，是否应接受辅助全身治疗仍然是一个挑战。没有随机临床试验研究曲妥珠单抗在这种情况下的疗效。本前瞻性观察性研究旨在探讨中国临床实践中辅助全身治疗的选择。
我们前瞻性地收集了 2017 年 1 月 1 日至 2019 年 12 月 31 日在山西省人民医院乳腺中心接受乳腺癌手术的 HER2 阳性乳腺癌（直径<1cm 且淋巴结阴性）患者的数据，并回顾性调查了基线临床病理特征与治疗策略、心脏毒性和疾病结局之间的关系。
在 168 例符合条件的患者中，102 例（60.7%）接受了曲妥珠单抗辅助全身治疗（AST+T），47 例（28%）接受了无曲妥珠单抗辅助全身治疗（AST），19 例（11.3%）未接受辅助全身治疗。多变量逻辑回归分析表明，年龄、肿瘤大小和激素受体状态与治疗选择显著相关。AST+T、AST 和无治疗的 3 年无侵袭性疾病生存概率分别为 100%、97.9%和 89.5%（P<0.001）。
大多数（60.7%）pT1a-b pN0 HER2 阳性乳腺癌患者接受了曲妥珠单抗辅助全身治疗，而只有 11.3%的患者未接受任何辅助全身治疗。肿瘤大小、年龄和激素受体状态影响治疗选择。与未接受辅助全身治疗的患者相比，接受曲妥珠单抗辅助全身治疗的患者 3 年无侵袭性疾病生存率显著更高。心脏不良事件罕见。
