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辅助内分泌治疗在 ER+、PR-、HER2-早期乳腺癌中的作用：真实世界数据的回顾性研究。

The role of adjuvant endocrine treatment in ER+, PR-, HER2- early breast cancer: a retrospective study of real-world data.

机构信息

General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.

Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

出版信息

Sci Rep. 2024 Nov 2;14(1):26377. doi: 10.1038/s41598-024-78341-2.

DOI:10.1038/s41598-024-78341-2
PMID:39487260
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11530533/
Abstract

PURPOSE: Estrogen receptor-positive (ER+), progesterone receptor-negative (PR-) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC) often developed resistance to endocrine treatment (ET). We aimed to explore (1) the different clinicopathological features between ER+/PR+/HER2- and ER+/PR-/HER2- BC, and (2) whether ER+/PR-/HER2- early BC patients could benefit from adjuvant ET. METHODS: All patients treated for ER+/HER2- early BC who underwent surgery between 2010 and 2021 from a BC database in China were retrospectively examined. The cases followed up for less than six months were excluded. RESULTS: The records of ER+/PR+/HER2- (n = 10843) and ER+/PR-/HER2- BC (n = 1193) cases were reviewed, with median follow-up times of 35.8 and 47.0 months, respectively. Compared with ER+/PR+/HER2- cases, ER+/PR-/HER2- BC occurred more in postmenopausal women (73.1% vs. 52.9%, p = 0.000) and were more likely to be T > 2 cm (40.6% vs. 37.6%, p = 0.048) and Ki67 > 20%+ (48.1% vs. 36.9%, p = 0.000). However, ER+/PR-/HER2- cases had fewer nodal involvement (32.9% vs. 36.9%, p = 0.000). Approximately 82.2% (981/1193) of ER+/PR-/HER2- patients received ET, while approximately 17.8% (212/1193) did not. Compared to patients did not receive adjuvant ET, the ET group had similar disease-free survival (DFS) (HR = 1.33, 95% confidence interval (CI): 0.68-2.59, p = 0.444) and overall survival (OS) (HR = 1.17, 95%CI: 0.37-3.68, p = 0.799). 65.7% of recurrent ER+/PR-/HER2- patients experienced distant relapse (65.7% vs. 48.2% (for ER+/PR + cases), p = 0.011). By comparison, recurrent ER+/PR+/HER2- patients were more likely to experience only local relapse (31.6% vs. 14.9% (for ER+/PR- cases), p = 0.007). CONCLUSIONS: ER+/PR-/HER2- BC was a special subtype with aggressive clinicopathological features and more tend to have distant metastasis rather than nodal involvement or local relapse. ER+/PR-/HER2- early BC did not seem to benefit from adjuvant ET.

摘要

目的：雌激素受体阳性（ER+）、孕激素受体阴性（PR-）和人表皮生长因子受体 2 阴性（HER2-）的乳腺癌（BC）通常对内分泌治疗（ET）产生耐药性。我们旨在探讨：（1）ER+/PR+/HER2-和 ER+/PR-/HER2-BC 之间不同的临床病理特征；（2）ER+/PR-/HER2-早期 BC 患者是否能从辅助 ET 中获益。

方法：回顾性分析了 2010 年至 2021 年间在中国 BC 数据库中接受 ER+/HER2-早期 BC 手术治疗的所有患者的病历。排除随访时间不足 6 个月的病例。

结果：共回顾了 ER+/PR+/HER2-（n=10843）和 ER+/PR-/HER2-BC（n=1193）病例，中位随访时间分别为 35.8 个月和 47.0 个月。与 ER+/PR+/HER2-病例相比，ER+/PR-/HER2-BC 更常见于绝经后女性（73.1% vs. 52.9%，p=0.000），且更倾向于 T＞2cm（40.6% vs. 37.6%，p=0.048）和 Ki67＞20%+（48.1% vs. 36.9%，p=0.000）。然而，ER+/PR-/HER2-病例的淋巴结受累情况更少（32.9% vs. 36.9%，p=0.000）。大约 82.2%（981/1193）的 ER+/PR-/HER2-患者接受了 ET，而大约 17.8%（212/1193）的患者未接受。与未接受辅助 ET 的患者相比，ET 组的无病生存（DFS）（HR=1.33，95%置信区间（CI）：0.68-2.59，p=0.444）和总生存（OS）（HR=1.17，95%CI：0.37-3.68，p=0.799）相似。65.7%的复发性 ER+/PR-/HER2-患者发生远处复发（65.7% vs. 48.2%（ER+/PR+病例），p=0.011）。相比之下，复发性 ER+/PR+/HER2-患者更可能仅发生局部复发（31.6% vs. 14.9%（ER+/PR-病例），p=0.007）。

结论：ER+/PR-/HER2-BC 是一种具有侵袭性临床病理特征的特殊亚型，更倾向于远处转移，而不是淋巴结受累或局部复发。ER+/PR-/HER2-早期 BC 似乎不能从辅助 ET 中获益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/d73f310035ff/41598_2024_78341_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/f51ba324af82/41598_2024_78341_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/e640acb12537/41598_2024_78341_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/ccd93ec40cba/41598_2024_78341_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/d73f310035ff/41598_2024_78341_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/f51ba324af82/41598_2024_78341_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/e640acb12537/41598_2024_78341_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/ccd93ec40cba/41598_2024_78341_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/caad/11530533/d73f310035ff/41598_2024_78341_Fig4_HTML.jpg

相似文献

[1]
The role of adjuvant endocrine treatment in ER+, PR-, HER2- early breast cancer: a retrospective study of real-world data.

Sci Rep. 2024-11-2

[2]
Real-world data on breast pathologic complete response and disease-free survival after neoadjuvant chemotherapy for hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer: a multicenter, retrospective study in China.

World J Surg Oncol. 2022-9-29

[3]
Shorter survival-times following adjuvant endocrine therapy in oestrogen- and progesterone-receptor positive breast cancer overexpressing HER2 and/or with an increased expression of vascular endothelial growth factor.

Med Oncol. 2009-1-7

[4]
Clinical validation of the EndoPredict test in node-positive, chemotherapy-treated ER+/HER2- breast cancer patients: results from the GEICAM 9906 trial.

Breast Cancer Res. 2014-4-12

[5]
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Cancer Med. 2024-6

[6]
Combined Estrogen Receptor and Progesterone Receptor Level Can Predict Survival Outcome in Human Epidermal Growth Factor Receptor 2-positive Early Breast Cancer.

Clin Breast Cancer. 2022-2

[7]
Real-World Data on Pathological Response and Survival Outcomes After Neoadjuvant Chemotherapy in HER2-Low Breast Cancer Patients.

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[8]
Retrospective analysis of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), Ki67 changes and their clinical significance between primary breast cancer and metastatic tumors.

PeerJ. 2024

[9]
Neoadjuvant Chemotherapy and Pathologic Complete Response in HR+/HER2- Breast Cancer: Impact of Tumor Ki67 and ER Status.

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[10]
Genomic Landscape and Endocrine-Resistant Subgroup in Estrogen Receptor-Positive, Progesterone Receptor-Negative, and HER2-Negative Breast Cancer.

Theranostics. 2018-12-8

本文引用的文献

[1]
ER+/PR- phenotype exhibits more aggressive biological features and worse outcome compared with ER+/PR+ phenotype in HER2-negative inflammatory breast cancer.

Sci Rep. 2024-1-2

[2]
Genetic and clinical landscape of ER + /PR- breast cancer in China.

BMC Cancer. 2023-12-4

[3]
Characterizing Clinicopathologic Features of Estrogen Receptor-Positive/Progesterone Receptor-Negative Breast Cancers.

Clin Breast Cancer. 2022-10

[4]
A novel immune subtype classification of ER-positive, PR-negative and HER2-negative breast cancer based on the genomic and transcriptomic landscape.

J Transl Med. 2021-9-20

[5]
Classification of PR-positive and PR-negative subtypes in ER-positive and HER2-negative breast cancers based on pathway scores.

BMC Med Res Methodol. 2021-5-22

[6]
Clinical study of first-line endocrine therapy for type ER+/PR+ and ER+/PR- advanced breast cancer.

Ann Palliat Med. 2021-1

[7]
Single Hormone Receptor-Positive Breast Cancers Have Distinct Characteristics and Survival.

Ann Surg Oncol. 2020-11

[8]
Estrogen Receptor Positive and Progesterone Receptor Negative Breast Cancer: the Role of Hormone Therapy.

Horm Cancer. 2020-8

[9]
Clinicopathological Characteristics and Breast Cancer-Specific Survival of Patients With Single Hormone Receptor-Positive Breast Cancer.

JAMA Netw Open. 2020-1-3

[10]
Clinical Characteristics and Outcomes of Single Versus Double Hormone Receptor-Positive Breast Cancer in 2 Large Databases.

Clin Breast Cancer. 2020-4

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