乳腺癌新辅助化疗中蒽环类药物的省略：一项基于人群的分析。

Omission of anthracyclines from neoadjuvant chemotherapy for breast cancer: a population-based analysis.

作者信息

Mata Danilo Giffoni M M, Sutradhar Rinku, Castelo Matthew, Hahn Ezra, Nguyen Lena, Rodin Danielle, Fatiregun Omolara, Trebinjac Sabina, Paszat Lawrence, Eisen Andrea, Jerzak Katarzyna J, Rakovitch Eileen

机构信息

Division of Medical Oncology, Verspeeten Family Cancer Centre, London Health Sciences Centre, London, ON, Canada.

Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

出版信息

Breast Cancer Res Treat. 2025 Aug 13. doi: 10.1007/s10549-025-07778-4.

DOI:10.1007/s10549-025-07778-4

PMID:40801982

Abstract

BACKGROUND

Most individuals diagnosed with high-risk breast cancer are treated with anthracycline-containing neoadjuvant chemotherapy (NAC). There is interest to identify individuals for whom anthracyclines can be avoided. A paucity of data exists on the extent to which anthracyclines are omitted in the neoadjuvant setting and its associated effectiveness.

OBJECTIVE

To investigate the extent to which anthracycline-free NAC is used in the treatment of breast cancer and the impact of its omission on risks of mortality.

METHODS

Population-based analysis of individuals diagnosed with stage I-III invasive breast cancer between 2012 and 2021 treated with NAC and surgery in Ontario, Canada. Baseline characteristics of patients who did and did not receive an anthracycline were compared. Five-year cumulative risks of breast cancer and all-cause mortality were calculated. Cause-specific hazard ratios (HRs) and 95% CIs were calculated using adjusted multivariable proportional hazards models for the whole cohort and subsets stratified by stage and receptor subtype.

RESULTS

The cohort includes 6672 patients; 6126 received an anthracycline, 546 received an anthracycline-free regimen. Median follow-up was 3.9 years. The 5-year cumulative incidence of breast cancer mortality was 12.3% for individuals treated with an anthracycline-free regimen and 14.5% for those who received an anthracycline (p = 0.10). On multivariable analysis, individuals treated with non-anthracycline NAC did not experience an increased risk of breast cancer mortality (HR = 0.88; 95% CI: 0.65,1.18, p = 0.38) or all-cause mortality (HR 0.86; 95% CI 0.67, 1.10, p = 0.23). For patients with stage I or II HER2+ disease, treatment with non-anthracycline NAC was associated with excellent survival.

CONCLUSIONS

Most individuals treated with NAC received an anthracycline but its omission for selected patients with early HER2+ breast cancer was associated with excellent outcomes.

摘要

背景

大多数被诊断为高危乳腺癌的患者接受含蒽环类药物的新辅助化疗（NAC）。人们希望确定可以避免使用蒽环类药物的患者。关于在新辅助治疗中省略蒽环类药物的程度及其相关疗效的数据很少。

目的

调查无蒽环类药物的NAC在乳腺癌治疗中的使用程度及其省略对死亡率风险的影响。

方法

对2012年至2021年间在加拿大安大略省接受NAC和手术治疗的I-III期浸润性乳腺癌患者进行基于人群的分析。比较接受和未接受蒽环类药物治疗的患者的基线特征。计算乳腺癌和全因死亡率的五年累积风险。使用调整后的多变量比例风险模型计算整个队列以及按阶段和受体亚型分层的亚组的特定病因风险比（HR）和95%置信区间（CI）。

结果

该队列包括6672名患者；6126名接受了蒽环类药物治疗，546名接受了无蒽环类药物的治疗方案。中位随访时间为3.9年。接受无蒽环类药物治疗方案的患者5年乳腺癌死亡率累积发生率为12.3%，接受蒽环类药物治疗的患者为14.5%（p = 0.10）。多变量分析显示，接受非蒽环类药物NAC治疗的患者乳腺癌死亡率风险（HR = 0.88；95% CI：0.65，1.18，p = 0.38）或全因死亡率风险（HR 0.86；95% CI 0.67，1.10，p = 0.23）没有增加。对于I期或II期HER2+疾病患者，非蒽环类药物NAC治疗与良好的生存率相关。