High Risk of Recurrence for Patients With Breast Cancer Who Have Human Epidermal Growth Factor Receptor 2-Positive, Node-Negative Tumors 1 cm or Smaller
High Risk of Recurrence for Patients With Breast Cancer Who Have Human Epidermal Growth Factor Receptor 2-Positive, Node-Negative Tumors 1 cm or Smaller
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DOI：
10.1200/jco.2009.23.2025
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发表时间：
2009-12-01
影响因子：
45.3
通讯作者：
Hortobagyi, Gabriel N.
中科院分区：
文献类型：
--
作者：
Gonzalez-Angulo, Ana M.;Litton, Jennifer K.;Hortobagyi, Gabriel N.
PurposeTo评估T1 a和T1 b，淋巴结阴性，人表皮生长因子受体2（HER 2）阳性乳腺癌的妇女复发的风险。MethodsWe回顾了965 T1 a，bN 0 M0乳腺癌诊断在我们的机构在1990年和2002年之间。如果通过免疫组化检测结果为3+，或者如果通过荧光原位杂交（FISH）检测结果为2.0或更高，则专门的乳腺病理学家确认为HER 2阳性。排除接受辅助化疗或曲妥珠单抗的患者。Kaplan-Meier乘积计算无复发生存期（RFS）和无远处复发生存期（DRFS）。拟合考克斯比例风险模型，以确定调整患者和疾病特征后HER 2状态与生存期之间的相关性。此外，350乳腺癌从其他两个机构用于validation.Results10%的患者有HER 2阳性肿瘤。在中位随访74个月时，有72例复发。HER 2阳性和HER 2阴性肿瘤患者的5年RFS率分别为77.1%和93.7%（P <0.001）。HER 2阳性和HER 2阴性肿瘤患者的5年DRFS率分别为86.4%和97.2%（P <0.001）。在多变量分析中，与HER 2阴性肿瘤患者相比，HER 2阳性肿瘤患者的复发风险（风险比[HR]，2.68; 95%CI，1.44至5.0; P = 0.002）和远处复发风险（HR，5.3; 95%CI，2.23至12.62; P <0.001）更高。HER 2阳性肿瘤患者的5.09倍（95%CI，2.56 ~ 10.14; P < .0001）复发率和复发次数分别为7.81次和7.81次，（95% CI，3.17 ~ 19.22; P < .0001）与激素受体阳性肿瘤患者相比，5年时远处复发率。阳性T1 abN 0 M0肿瘤具有显著的复发风险，应考虑进行全身性抗HER 2辅助治疗。
PurposeTo evaluate the risk of recurrence in women diagnosed with T1a and T1b, node-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancer.MethodsWe reviewed 965 T1a, bN0M0 breast cancers diagnosed at our institution between 1990 and 2002. Dedicated breast pathologists confirmed HER2 positivity if 3+ by immunohistochemistry or if it had a ratio of 2.0 or greater by fluorescence in situ hybridization ( FISH). Patients who received adjuvant chemotherapy or trastuzumab were excluded. Kaplan-Meier product was used to calculate recurrence-free survival (RFS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were fit to determine associations between HER2 status and survival after adjustment for patient and disease characteristics. Additionally, 350 breast cancers from two other institutions were used for validation.ResultsTen percent of patients had HER2-positive tumors. At a median follow-up of 74 months, there were 72 recurrences. The 5-year RFS rates were 77.1% and 93.7% in patients with HER2-positive and HER2-negative tumors, respectively (P < .001). The 5-year DRFS rates were 86.4% and 97.2% in patients with HER2-positive and HER2-negative tumors, respectively (P < .001). In multivariate analysis, patients with HER2-positive tumors had higher risks of recurrence (hazard ratio [HR], 2.68; 95% CI, 1.44 to 5.0; P = .002) and distant recurrence (HR, 5.3; 95% CI, 2.23 to 12.62; P < .001) than those with HER2-negative tumors. Patients with HER2-positive tumors had 5.09 times (95% CI, 2.56 to 10.14; P < .0001) the rate of recurrences and 7.81 times (95% CI, 3.17 to 19.22; P < .0001) the rate of distant recurrences at 5 years compared with patients who had hormone receptor-positive tumors.ConclusionPatients with HER2-positive T1abN0M0 tumors have a significant risk of relapse and should be considered for systemic, anti-HER2, adjuvant therapy.