Her2/neu-positive disease does not increase risk of locoregional recurrence for patients treated with neoadjuvant doxorubicin-based chemotherapy, mastectomy, and radiotherapy
Her2/neu-positive disease does not increase risk of locoregional recurrence for patients treated with neoadjuvant doxorubicin-based chemotherapy, mastectomy, and radiotherapy
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DOI：
10.1016/j.ijrobp.2004.02.018
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发表时间：
2004-08-01
影响因子：
7
通讯作者：
Sahin, AA
中科院分区：
文献类型：
--
作者：
Buchholz, TA;Huang, EH;Sahin, AA
目的：临床前数据表明Her 2/neu的过表达赋予细胞辐射抗性。我们回顾性研究了Her 2/neu阳性疾病是否与局部复发（LRR）乳腺癌切除术后放疗（RT）乳腺cancer.Methods和材料：从337例患者在四个机构的前瞻性临床试验新辅助阿霉素为基础的化疗，乳房切除术，RT的数据进行了审查。这些试验是在1989年至2000年期间进行的。在337例患者中，108例（32%）的肿瘤进行了Her 2/neu检测，阳性定义为3+免疫组织化学染色或荧光原位杂交检测的基因扩增。结果：Her 2/neu阳性32例，阴性76例。Her 2/neu阳性肿瘤与雌激素受体阴性疾病（p = 0.03）、诊断时锁骨上疾病（p = 0.027）和化疗后阳性淋巴结数量（p = 0.026）相关。尽管存在这些不良特征，Her 2/neu阳性肿瘤患者与Her 2/neu阴性肿瘤患者的精算总体LRR率大致相当（5年率分别为17.5%与13.9%; 10年率分别为17.5%与18.9%; p = 0.757）。在针对N分期和雌激素受体状态调整的LRR的考克斯回归分析中，Her 2/neu阳性的风险比为0.89（95%置信区间，0.31-2.59; p = 0.83）。
Purpose: Preclinical data suggest that overexpression of Her2/neu confers cellular radioresistance. We retrospectively studied whether Her2/neu-positive disease was associated with locoregional recurrence (LRR) after postmastectomy radiotherapy (RT) for breast cancer.Methods and Materials: Data from 337 patients treated in four institutional prospective clinical trials neoadjuvant doxorubicin-based chemotherapy, mastectomy, and RT were reviewed. The trials were conducted between 1989 and 2000. Of the 337 patients, 108 (32%) had tumors that were tested for Her2/neu, with positivity defined by 3+ immunohistochemistry staining or gene amplification detected by fluorescence in situ hybridization. RT was delivered to the chest wall and draining lymphatics (median dose, 50 Gy) followed by a chest wall boost (median dose, 10 Gy).Results: Thirty-two patients had Her2/neu-positive disease and 76 patients had Her2/neu-negative disease. The Her2/neu-positive tumors were associated with a greater rate of estrogen receptor-negative disease (p = 0.03), the presence of supraclavicular disease at diagnosis (p = 0.027), and a greater number of positive lymph nodes after chemotherapy (p = 0.026). Despite these adverse features, the actuarial overall LRR rate was roughly equivalent for the patients with Her2/neu-positive tumors vs. those with Her2/neu-negative tumors (5-year rate 17.5% vs. 13.9%, respectively; 10-year rate 17.5% vs. 18.9%, respectively; p = 0.757). On Cox regression analysis of LRR adjusted for N stage and estrogen receptor status, the hazard ratio for Her2/neu positivity was 0.89 (95% confidence interval, 0.31-2.59; p = 0.83).Conclusion: Her2/neu overexpression does not appear to predispose to LRR after neoadjuvant doxorubicin-based chemotherapy, mastectomy, and RT. (C) 2004 Elsevier Inc.