新药治疗时代初治IV期HER2阳性乳腺癌的原发灶手术
Primary site surgery of de novo stage IV HER2-positive breast cancer in the era of new drug treatments.
作者信息
Lu Guanyu, Jia Lin, Yang Ruohan, Liu Yutong, Lv Zheng, Cui Jiuwei
机构信息
Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China.
Departments of Breast Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.
出版信息
Front Oncol. 2024 Jan 9;13:1308854. doi: 10.3389/fonc.2023.1308854. eCollection 2023.
OBJECTIVE
The surgical treatment of the primary site has been a subject of controversy in patients with de novo metastatic breast cancer. In recent years, studies using large databases and retrospective analyses have provided evidence of the survival benefits of localized surgery for these patients. However, due to the improved prognosis associated with novel antitumor agents and the widespread use of anti-HER2 therapy, it is important to investigate the role of primary site surgery in the context of new drug treatments for stage IV HER2-positive breast cancer.
METHODS
This retrospective analysis included patients with metastatic breast cancer at diagnosis who were consulted at the First Hospital of Jilin University between 2016 and 2022. We compared the patients' clinical and pathological characteristics, treatment regimens, and prognosis between the surgery and non-surgery groups.
RESULTS
A total of 96 patients with stage IV HER2-positive breast cancer were included in the study, with 24 patients (25%) undergoing surgery for the primary lesion. Patients with lower Eastern Cooperative Oncology Group (ECOG) scores, earlier T-stage, metastases confined to one organ/site, and fewer metastases were more likely to undergo surgery. Patients in the surgical group had longer progression-free survival (median 25.7 . 15.9 months, p=0.073) and overall survival (median 79.1 . 48 months, p=0.073) compared to patients in the non-surgical group, however, there was no statistical difference. Univariate and multivariate Cox regression analysis suggested that the choice of first-line targeted therapy regimens rather than surgical treatment influenced the patients' prognoses. In the subgroup of patients receiving first-line targeted therapy with trastuzumab plus pertuzumab, the decision to undergo surgery on the primary site did not have a statistically significant effect on prognosis.
CONCLUSION
Primary site surgery does not improve the prognosis of de novo stage IV HER2-positive breast cancer. In the era of anti-HER2 therapy, primary surgery is not recommended, except in exceptional circumstances.
目的
对于初发性转移性乳腺癌患者，原发部位的手术治疗一直存在争议。近年来，使用大型数据库和回顾性分析的研究提供了局部手术对这些患者生存有益的证据。然而，由于新型抗肿瘤药物带来的预后改善以及抗HER2治疗的广泛应用，在IV期HER2阳性乳腺癌的新药治疗背景下研究原发部位手术的作用很重要。
方法
这项回顾性分析纳入了2016年至2022年在吉林大学第一医院就诊的诊断为转移性乳腺癌的患者。我们比较了手术组和非手术组患者的临床和病理特征、治疗方案及预后。
结果
该研究共纳入96例IV期HER2阳性乳腺癌患者，其中24例（25%）对原发灶进行了手术。东部肿瘤协作组（ECOG）评分较低、T分期较早、转移局限于一个器官/部位且转移灶较少的患者更有可能接受手术。与非手术组患者相比，手术组患者的无进展生存期更长（中位值25.7对15.9个月，p = 0.073）和总生存期更长（中位值79.1对48个月，p = 0.073），然而，差异无统计学意义。单因素和多因素Cox回归分析表明，一线靶向治疗方案的选择而非手术治疗影响患者的预后。在接受曲妥珠单抗加帕妥珠单抗一线靶向治疗的患者亚组中，对原发部位进行手术的决定对预后没有统计学上的显著影响。
结论
原发部位手术并不能改善初发性IV期HER2阳性乳腺癌的预后。在抗HER2治疗时代，除特殊情况外，不建议进行原发手术。
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