Lee Min Jung, Jung Ji-Jung, Cheun Jong-Ho, Kang Eunhye, Kim Hong-Kyu, Lee Han-Byoel, Moon Hyeong-Gon, Han Wonshik
Department of surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Breast. 2025 Jun;81:104449. doi: 10.1016/j.breast.2025.104449. Epub 2025 Mar 17.
The Rx for positive node endocrine-responsive breast cancer trial highlighted that premenopausal (PRE) women who underwent chemotherapy exhibited superior survival rates compared to postmenopausal (POST) counterparts, but showed worse survival without chemotherapy. This raises the question whether application of ovarian function suppression (OFS) in PRE women aligns with their cancer biology, treatment response, and outcomes observed in POST women.
Data from the Seoul National University Hospital breast cancer cohort focusing on patients with stage pT1-3, pN0-1, estrogen receptor-positive (ER+), and HER2-negative breast cancer were analyzed. Survival outcomes, including invasive disease-free survival (iDFS) and distant relapse-free survival (DRFS), were compared between PRE women receiving OFS and POST women, with chemotherapy usage as a stratification factor. Propensity score matching was performed.
We analyzed 3483 patients, comprising 2901 POST and 582 PRE women with OFS. In the cohort without chemotherapy, the 10-year iDFS rates were 90.3 % and 88.3 % (hazard ratio [HR], 1.32; p = 0.16), and 10-year DRFS rates were 94.3 % and 96.1 % (HR, 0.78; p = 0.41) for POST and PRE women with OFS, respectively. Among women treated with chemotherapy, 10-year iDFS rates were 83.0 % and 79.5 % (HR, 1.21; p = 0.37), and DRFS rates were 86.7 % and 85.7 % (HR, 1.14; p = 0.58) for POST and PRE women with OFS, respectively. These results remained consistent after PSM.
Oncological outcomes of PRE women receiving OFS were comparable to those of POST women with ER+ and HER2-early breast cancer, irrespective of chemotherapy administration.
“阳性淋巴结内分泌反应性乳腺癌试验的治疗方案（Rx）”强调，接受化疗的绝经前（PRE）女性比绝经后（POST）女性表现出更高的生存率，但在未接受化疗的情况下生存率更低。这就提出了一个问题，即绝经前女性应用卵巢功能抑制（OFS）是否与其癌症生物学特性、治疗反应以及绝经后女性所观察到的结果相符。
分析了首尔国立大学医院乳腺癌队列中pT1 - 3期、pN0 - 1期、雌激素受体阳性（ER +）且人表皮生长因子受体2阴性（HER2 -）乳腺癌患者的数据。以化疗使用情况作为分层因素，比较接受OFS的绝经前女性和绝经后女性的生存结局，包括无侵袭性疾病生存期（iDFS）和远处无复发生存期（DRFS）。进行了倾向评分匹配。
我们分析了3483例患者，其中包括2901例绝经后女性和582例接受OFS的绝经前女性。在未接受化疗的队列中，接受OFS的绝经后女性和绝经前女性的10年iDFS率分别为90.3%和88.3%（风险比[HR]，1.32；p = 0.16），10年DRFS率分别为94.3%和96.1%（HR，0.78；p = 0.41）。在接受化疗的女性中，接受OFS的绝经后女性和绝经前女性的10年iDFS率分别为83.0%和79.5%（HR，1.21；p = 0.37），DRFS率分别为86.7%和85.7%（HR，1.14；p = 0.58）。倾向评分匹配后这些结果仍然一致。
接受OFS的绝经前女性的肿瘤学结局与雌激素受体阳性且人表皮生长因子受体2阴性的早期乳腺癌绝经后女性相当，无论是否进行化疗。
