Dong Hong, Su Xinyu, Li Xun, Fu Peng, Tan Lun
Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
J Cancer Res Clin Oncol. 2023 Nov;149(14):12637-12646. doi: 10.1007/s00432-023-05124-z. Epub 2023 Jul 14.
To wholly evaluate the prognostic value of CHT for pT1-3N0-1 breast cancer patients with HR+, HER2- subtype using the Surveillance, Epidemiology, and End Results (SEER) database.
A total of 126,102 eligible cases diagnosed between January 2010 and December 2018 were included in the SEER database. A propensity-score matched (PSM) study with competing risk analysis was conducted. The Kaplan-Meier method was used to visualize the survival disparities between chemotherapy (CHT) and no CHT groups. The cumulative incidences of different subgroups were compared by Fine-Gray's test.
Before PSM, patients in the CHT group had worse OS and CSS (both P < 0.001). After PSM, we were surprised that patients in the CHT group had a better OS than those in the no CHT group (HR 0.74, 95% CI 0.68-0.80, P < 0.001), while no significant survival disparities were observed for CSS (HR 1.00, 95% CI 0.89-1.12, P = 0.952). In the competing risk analysis, the OS disparities between the CHT and no CHT groups were mainly attributed to deaths of other causes (subdistribution HR [95% CI] 0.50 [0.44-0.57]). After adjusting for other competitive risk events, there was no significant difference in cumulative death risk of breast cancer between the CHT and no CHT groups (subdistribution HR [95% CI] 1.01 [0.90-0.1.13]).
The present study is the first, to our knowledge, to wholly evaluate the prognostic value of CHT for pT1-3N0-1 breast cancer patients with HR+, HER2- subtype using a propensity-score matched study with competing risk analysis. All pT1-3N0-1 breast cancer patients with HR+, HER2- subtype do not benefit from CHT. Genetic testing may be the only effective tool to determine the need for CHT at the present.
使用监测、流行病学和最终结果（SEER）数据库全面评估化疗（CHT）对HR+、HER2-亚型的pT1-3N0-1期乳腺癌患者的预后价值。
SEER数据库纳入了2010年1月至2018年12月期间诊断的126,102例符合条件的病例。进行了一项倾向评分匹配（PSM）研究并采用竞争风险分析。采用Kaplan-Meier方法直观显示化疗（CHT）组和非CHT组之间的生存差异。通过Fine-Gray检验比较不同亚组的累积发病率。
在PSM之前，CHT组患者的总生存期（OS）和癌症特异性生存期（CSS）较差（均P<0.001）。PSM之后，我们惊讶地发现CHT组患者的OS优于非CHT组患者（风险比[HR]0.74，95%置信区间[CI]0.68-0.80，P<0.001），而CSS未观察到显著的生存差异（HR 1.00，95%CI 0.89-1.12，P=0.952）。在竞争风险分析中，CHT组和非CHT组之间的OS差异主要归因于其他原因导致的死亡（亚分布HR[95%CI]0.50[0.44-0.57]）。在调整其他竞争风险事件后，CHT组和非CHT组之间乳腺癌累积死亡风险无显著差异（亚分布HR[95%CI]1.01[0.90-1.13]）。
据我们所知，本研究首次采用倾向评分匹配研究并结合竞争风险分析全面评估了CHT对HR+、HER2-亚型的pT1-3N0-1期乳腺癌患者的预后价值。所有HR+、HER2-亚型的pT1-3N0-1期乳腺癌患者均不能从CHT中获益。基因检测可能是目前确定是否需要CHT的唯一有效工具。
