Watanuki Rurina, Sakai Hitomi, Takehara Yuri, Yoshida Atsushi, Hayashi Naoki, Ozaki Yukinori, Kataoka Akemi, Uehiro Natsue, Kamio Hidenori, Onishi Mai, Fushimi Atsushi, Ikeno Takashi, Wakabayashi Masashi, Iida Mayumi, Kawaguchi Tsutomu, Takano Toshimi
Department of Breast Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
Advanced Cancer Translational Research Institute, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku,, Tokyo, 142-8555, Japan.
Breast Cancer. 2025 Apr 10. doi: 10.1007/s12282-025-01700-y.
Patients with early recurrence of hormone receptor (HR)-positive, HER2-negative (HR+/HER2-) breast cancer have a poor prognosis. We aimed to identify clinical and pathological risk factors for recurrence within three years after surgery of HR+/HER2- breast cancer.
We retrospectively reviewed clinical data of patients with stage II-III HR+/HER2- breast cancer who received adjuvant endocrine therapy from January 1, 2012 to January 1, 2017 at five institutions. Using univariable and multivariable analyses, we determined risk factors for invasive disease-free survival (IDFS). A nomogram was generated using variables from the multivariable analysis to predict 3-year IDFS rate.
A total of 2732 patients were analyzed, with a median follow-up of 7.1 years. The 3-year IDFS rate was 92.1%. Multivariable analysis for IDFS revealed significant risk factors: age (40-69 vs. 20-39 years: HR 0.69, p = 0.011), nuclear grade (Grade 2 vs. Grade 1: HR 1.66, p < 0.001; Grade 3 vs. Grade 1: HR 1.64, p < 0.001), vascular invasion (Yes vs. No: HR 1.36, p = 0.027), pathological invasive tumor size (2-5 cm vs. < 2 cm: HR 1.75, p < 0.001; ≥ 5 cm vs. < 2 cm: HR 2.07, p < 0.001), number of positive lymph nodes (≥ 4 vs.0: HR 1.70, p < 0.001), and neoadjuvant chemotherapy (NAC) (Yes vs. No: HR 2.41, p < 0.001). The nomogram's concordance index was 0.68.
Younger age, nuclear grade, vascular invasion, tumor size and number of lymph node metastases were identified as independent risk factors for early recurrence. Patients whose physicians chose NAC had worse survival than those who did not.
激素受体（HR）阳性、人表皮生长因子受体2阴性（HR+/HER2-）乳腺癌早期复发的患者预后较差。我们旨在确定HR+/HER2-乳腺癌术后3年内复发的临床和病理危险因素。
我们回顾性分析了2012年1月1日至2017年1月1日在五家机构接受辅助内分泌治疗的II-III期HR+/HER2-乳腺癌患者的临床资料。通过单变量和多变量分析，我们确定了无侵袭性疾病生存期（IDFS）的危险因素。使用多变量分析中的变量生成列线图，以预测3年IDFS率。
共分析了2732例患者，中位随访时间为7.1年。3年IDFS率为92.1%。IDFS的多变量分析显示了显著的危险因素：年龄（40-69岁与20-39岁：HR 0.69，p = 0.011）、核分级（2级与1级：HR 1.66，p < 0.001；3级与1级：HR 1.64，p < 0.001）、血管侵犯（是与否：HR 1.36，p = 0.027）、病理侵袭性肿瘤大小（2-5 cm与<2 cm：HR 1.75，p < 0.001；≥5 cm与<2 cm：HR 2.07，p < 0.001）、阳性淋巴结数目（≥4个与0个：HR 1.70，p < 0.001）和新辅助化疗（NAC）（是与否：HR 2.41，p < 0.001）。列线图的一致性指数为0.68。
年龄较小、核分级、血管侵犯、肿瘤大小和淋巴结转移数目被确定为早期复发的独立危险因素。选择NAC的患者生存率低于未选择NAC的患者。
