Department of Breast Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China.
Oncol Res Treat. 2023;46(12):511-519. doi: 10.1159/000534856. Epub 2023 Nov 6.
Although breast-conserving therapy (BCT) promises at least a similar survival rate for patients with early breast cancer compared with mastectomy, its efficacy in patients with human epidermal growth factor receptor 2 (HER2)-positive tumors remains unclear. Therefore, we conducted this study to explore differential effects of BCT and mastectomy on survival outcomes of patients with early-stage HER2-positive breast cancer.
Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and basic characteristics of patients who received either BCT or mastectomy were balanced using propensity score matching (PSM). Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards regression were performed.
In total, 20,277 patients were diagnosed with T1-2N0-1M0 HER2-positive breast cancer between 2010 and 2015. After PSM, 6,185 pairs of patients were enrolled for further analysis. Compared with those undergoing mastectomy, patients receiving BCT had superior overall survival (OS) (hazard ratio [HR], 0.63; 95% confidence interval [CI]: 0.55-0.73; p < 0.001) and breast cancer-specific survival (BCSS) (HR: 0.59; 95% CI: 0.48-0.71; p < 0.001). The subgroup analyses revealed that survival outcomes (OS and BCSS) of BCT were better than those of mastectomy among estrogen receptor (ER)+/progesterone receptor (PR)+/HER2+, ER+/PR-/HER2+, and ER-/PR-/HER2+ subtypes (p < 0.05 for all); however, patients with ER-/PR+/HER2+ subtypes who underwent BCT had similar OS and BCSS (p > 0.05 for both) to those treated with mastectomy.
DISCUSSION/CONCLUSION: Despite the aggressiveness of the disease, we found that BCT may confer better long-term survival than mastectomy for patients with T1-2N0-1M0 HER2-positive breast cancer, particularly for those with ER+/PR+/HER2+, ER+/PR-/HER2+, and ER-/PR-/HER2+ subtypes. In addition, our study provided insights into the clinical applications of BCT. However, this retrospective study has introduced several inevitable limitations, and further prospective research is warranted to verify these conclusions.
尽管保乳治疗（BCT）在早期乳腺癌患者的生存方面至少与乳房切除术相当，但在人表皮生长因子受体 2（HER2）阳性肿瘤患者中的疗效尚不清楚。因此，我们进行了这项研究，以探讨 BCT 和乳房切除术对早期 HER2 阳性乳腺癌患者生存结局的差异影响。
数据来自监测、流行病学和最终结果（SEER）数据库，使用倾向评分匹配（PSM）平衡接受 BCT 或乳房切除术的患者的基本特征。进行 Kaplan-Meier 分析、对数秩检验和 Cox 比例风险回归分析。
2010 年至 2015 年期间，共有 20277 例 T1-2N0-1M0 期 HER2 阳性乳腺癌患者被诊断。PSM 后，共纳入 6185 对患者进行进一步分析。与接受乳房切除术的患者相比，接受 BCT 的患者具有更好的总生存（OS）（风险比[HR]，0.63；95%置信区间[CI]：0.55-0.73；p < 0.001）和乳腺癌特异性生存（BCSS）（HR：0.59；95%CI：0.48-0.71；p < 0.001）。亚组分析显示，BCT 的生存结局（OS 和 BCSS）在雌激素受体（ER）+/孕激素受体（PR）+/HER2+、ER+/PR-/HER2+和 ER-/PR-/HER2+亚型中优于乳房切除术（均 p < 0.05）；然而，接受 BCT 的 ER-/PR+/HER2+亚型患者的 OS 和 BCSS 与乳房切除术相似（均 p > 0.05）。
讨论/结论：尽管疾病侵袭性较强，但我们发现 BCT 可为 T1-2N0-1M0 期 HER2 阳性乳腺癌患者提供比乳房切除术更好的长期生存，特别是对于 ER+/PR+/HER2+、ER+/PR-/HER2+和 ER-/PR-/HER2+亚型患者。此外，我们的研究为 BCT 的临床应用提供了见解。然而，这项回顾性研究带来了一些不可避免的局限性，需要进一步的前瞻性研究来验证这些结论。
