Wang Xuelian, Shang Yuhang, Zhang Jiayang, Liu Jiangwei, Fang Zhengbo, Liu Yansong, Cheng Weilun, Duan Yunqiang, Hu Anbang, Zhang Jiarui, Li Mingcui, Li Yanling, Zhang Hanyu, Rong Zhiyuan, S Shakila Suborna, Kong Fanjing, Guo Baoliang
Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Cancer. 2025 Jan 1;131(1):e35581. doi: 10.1002/cncr.35581. Epub 2024 Sep 22.
Persistent debates exist regarding the superiority of neoadjuvant therapy (NAT) over adjuvant therapy (AT) for patients with T1c, node-negative, human epidermal growth factor receptor 2-positive (HER2+) breast cancer, and relevant guidelines for these patients are lacking.
Data on patients with T1cN0M0-stage HER2+ breast cancer who received chemotherapy and surgery were extracted from 2010 to 2020 from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to create well-balanced cohorts for the NAT and AT groups. Kaplan-Meier (KM) analysis and Cox proportional hazards models were used to assess the differences between NAT and AT in terms of overall survival (OS) and breast cancer-specific survival (BCSS). Additionally, logistic regression models were used to explore factors associated with response to NAT.
After PSM, 2140 patient pairs were successfully matched, which achieved a balanced distribution between the NAT and AT groups. KM curves revealed similar OS and BCSS between patients receiving NAT and those undergoing AT. A multivariate Cox model identified achieving pathological complete response (pCR) after NAT, compared with AT, as a protective prognostic factor for OS (hazard ratio, 0.52; 95% CI, 0.35-0.77; p < .001) and BCSS (hazard ratio, 0.60; 95% CI, 0.37-0.98; p = .041). A logistic regression model revealed that White race and hormone receptor-negative status independently predicted pCR.
For patients with T1cN0M0-stage HER2+ breast cancer, NAT demonstrated comparable OS and BCSS to AT. Patients who achieved pCR after NAT exhibited significantly better survival outcomes compared with those who received AT.
对于T1c期、淋巴结阴性、人表皮生长因子受体2阳性（HER2+）乳腺癌患者，新辅助治疗（NAT）是否优于辅助治疗（AT）一直存在争议，且缺乏针对这些患者的相关指南。
从监测、流行病学和最终结果数据库中提取2010年至2020年接受化疗和手术的T1cN0M0期HER2+乳腺癌患者的数据。采用倾向评分匹配（PSM）为NAT组和AT组创建均衡的队列。采用Kaplan-Meier（KM）分析和Cox比例风险模型评估NAT和AT在总生存期（OS）和乳腺癌特异性生存期（BCSS）方面的差异。此外，采用逻辑回归模型探讨与NAT反应相关的因素。
PSM后，成功匹配了2140对患者，实现了NAT组和AT组之间的均衡分布。KM曲线显示，接受NAT的患者与接受AT的患者的OS和BCSS相似。多变量Cox模型确定，与AT相比，NAT后达到病理完全缓解（pCR）是OS（风险比，0.52；95%CI，0.35-0.77；p<.001）和BCSS（风险比，0.60；95%CI，0.37-0.98；p=0.041）的保护性预后因素。逻辑回归模型显示，白种人和激素受体阴性状态独立预测pCR。
对于T1cN0M0期HER2+乳腺癌患者，NAT的OS和BCSS与AT相当。NAT后达到pCR的患者与接受AT的患者相比，生存结局明显更好。
