Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Breast and Thyroid Surgical Oncology, Social Medical Corporation Hakuaikai Sagara Hospital, Kagoshima, Japan.
Breast Cancer. 2024 Jul;31(4):581-592. doi: 10.1007/s12282-024-01572-8. Epub 2024 Apr 29.
Anthracycline- and taxane-based chemotherapy regimens are established treatments for human epidermal growth factor receptor (HER)2-negative early-stage breast cancer with high risk of recurrence. This study examined the prevalence of these chemotherapy regimens as perioperative therapy, the patterns of retreatment, and factors influencing prescription choices in Japan.
This observational cohort study focused on high-risk early-stage breast cancer patients not undergoing anti-HER2 therapy, utilizing data from a hospital-based claims database in Japan spanning from April 2008 to September 2021.
Of 42,636 high-risk patients who underwent breast cancer surgery, 32,133 (75.4%) were categorized as having luminal-type (received endocrine therapy) and 10,503 (24.6%) as having triple-negative cancer (not receiving any endocrine therapies). Most patients (98.7%) with luminal-type breast cancer received perioperative therapy, and 40.3% of those received anthracycline/taxane. In the triple-negative group, 57.0% of all patients received perioperative therapy and of those, 93.4% received anthracycline/taxane. Being over 40 years old, having an early stage (clinical stage ≤ II), and receiving treatment in non-specialized facilities were associated with less use of anthracycline/taxane in the luminal-type group. For the triple-negative group, associated factors with less use of anthracycline/taxane included being over 60 years old, treatment in small hospital (capacity < 200 beds), and treatment in non-specialized facilities.
Approximately half the patients in both the luminal-type and triple-negative groups were prescribed anthracycline and/or taxane for perioperative chemotherapy. The choice was associated with patient age, cancer stage, and the scale and specialization of the treatment facilities. This study sheds light on the current state of breast cancer treatment practices in Japan.
蒽环类和紫杉类化疗方案是人表皮生长因子受体（HER）2 阴性、复发风险高的早期乳腺癌的既定治疗方法。本研究考察了这些化疗方案在日本作为围手术期治疗的应用情况、再治疗模式以及影响处方选择的因素。
本观察性队列研究聚焦于未接受抗 HER2 治疗的高危早期乳腺癌患者，利用了日本一家医院基于索赔数据库的数据，时间跨度为 2008 年 4 月至 2021 年 9 月。
在 42636 例高危患者中，32133 例（75.4%）为 luminal 型（接受内分泌治疗），10503 例（24.6%）为三阴性乳腺癌（未接受任何内分泌治疗）。大多数 luminal 型乳腺癌患者（98.7%）接受了围手术期治疗，其中 40.3%接受了蒽环类/紫杉类治疗。在三阴性组中，所有患者的 57.0%接受了围手术期治疗，其中 93.4%接受了蒽环类/紫杉类治疗。年龄在 40 岁以上、分期较早（临床分期≤Ⅱ期）和在非专科医疗机构接受治疗与 luminal 型组中蒽环类/紫杉类药物使用率较低相关。对于三阴性组，蒽环类/紫杉类药物使用率较低的相关因素包括年龄在 60 岁以上、在小医院（床位数<200）治疗以及在非专科医疗机构治疗。
luminal 型和三阴性组的患者中，约有一半接受了蒽环类和/或紫杉类药物用于围手术期化疗。这种选择与患者年龄、癌症分期以及治疗机构的规模和专业化程度有关。本研究揭示了日本乳腺癌治疗现状。
