Ibrahim Ezzeldin M, Refae Ahmed A, Bayer Ali M, Abdullah Nouf, Al-Foheidi Meteb E
Oncology Department, King's College Hospital London, Jeddah 23412, Saudi Arabia.
Medical Imaging Department and Breast Unit, King's College Hospital London, Jeddah 23412, Saudi Arabia.
World J Oncol. 2025 Jun;16(3):276-285. doi: 10.14740/wjon2578. Epub 2025 Jun 9.
While the prognosis for patients with human epidermal growth factor receptor 2 (HER2)-positive pT1a-bN0M0 breast cancer is generally favorable, the optimal approach to personalize adjuvant treatment for T1a tumors remains unclear, which prompted an impetus to conduct a systematic review and meta-analysis for the latter group.
We examined the literature for studies that provided relevant data about HER2-positive T1a patients. Patient and disease characteristics, therapy details, and survival outcomes were extracted.
Thirteen studies with 2,089 patients were eligible; four were prospective and nine were retrospective. In the studies where patients did not receive chemotherapy or anti-HER2 therapy, the prognosis was generally favorable, with disease-free survival (DFS) and overall survival of approximately 92% to 99%. Studies comparing treated versus untreated patients showed a survival benefit that varied between 2% and 15%, favoring adjuvant therapy without reaching statistical significance. In the only included randomized trial where all patients received adjuvant paclitaxel and trastuzumab, 10% demonstrated 5-year invasive DFS events. A meta-analysis of four studies showed a nonsignificant survival advantage trend among treated patients. There was inconsistency about the prognostic role of the co-existing hormone receptor status.
Patients with HER2-positive T1aN0 have a favorable prognosis; the benefit of adjuvant chemotherapy plus anti-HER2 varied and showed no convincing statistically significant benefit. The decision to offer adjuvant therapy should balance the expected benefits and risks. Prospective trials that include this population should be able to identify who should receive adjuvant therapy and determine the magnitude of benefit.
虽然人表皮生长因子受体2（HER2）阳性pT1a - bN0M0乳腺癌患者的预后总体良好，但针对T1a肿瘤患者个体化辅助治疗的最佳方法仍不明确，这促使人们对后一组患者进行系统评价和荟萃分析。
我们检索了提供HER2阳性T1a患者相关数据的研究文献。提取了患者和疾病特征、治疗细节及生存结局。
13项研究共纳入2089例患者；4项为前瞻性研究，9项为回顾性研究。在患者未接受化疗或抗HER2治疗的研究中，预后总体良好，无病生存率（DFS）和总生存率约为92%至99%。比较治疗组与未治疗组患者的研究显示生存获益在2%至15%之间，支持辅助治疗，但未达到统计学意义。在唯一纳入的随机试验中，所有患者均接受辅助紫杉醇和曲妥珠单抗治疗，10%的患者出现5年浸润性DFS事件。对4项研究的荟萃分析显示，治疗组患者存在无统计学意义的生存优势趋势。关于共存激素受体状态的预后作用存在不一致性。
HER2阳性T1aN0患者预后良好；辅助化疗加抗HER2治疗的获益各不相同，且未显示出令人信服的统计学显著获益。提供辅助治疗的决策应权衡预期的获益和风险。纳入该人群的前瞻性试验应能够确定谁应接受辅助治疗并确定获益程度。
