Trends in Neoadjuvant Endocrine Therapy Use and Impact on Rates of Breast Conservation in Hormone Receptor-Positive Breast Cancer: A National Cancer Data Base Study.
Trends in Neoadjuvant Endocrine Therapy Use and Impact on Rates of Breast Conservation in Hormone Receptor-Positive Breast Cancer: A National Cancer Data Base Study.
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DOI：
10.1245/s10434-016-5585-5
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发表时间：
2017-02
影响因子：
3.7
通讯作者：
Boughey JC
中科院分区：
文献类型：
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作者：
Chiba A;Hoskin TL;Heins CN;Hunt KK;Habermann EB;Boughey JC
ACOSOG Z1031表明，新辅助内分泌治疗（NET）增加了绝经后临床肿瘤2-4c期雌激素受体阳性乳腺癌患者保乳手术（BCS）的发生率。我们评估了与Z1031试验进行相关的NET使用趋势以及NET对BCS发病率的影响。使用国家癌症数据库（NCDB），我们确定了2004-2012年年龄≥50岁的所有cT2-4c激素受体阳性乳腺癌患者。研究了z1031前（2004-2006）、z1031期间（2007-2009）和z1031后（2010-2012）的时间间隔。采用多变量逻辑回归进行校正分析。77,272例患者中，2294例（3.0%）接受了NET治疗。临床T分期分布为cT2 66,885 (86.6%), cT3 7,318（9.5%）和cT4a-c 3,069（4.0%）。从z1031之前的2.7%到z1031之后的3.2%。z1031后与z1031前的净校正OR为1.28 （95% CI: 1.13-1.45, p<0.001）。NET的使用因临床T分期而异；在cT2患者中，从z1031前的1.8%增加到z1031后的2.4% (p<0.001)；在cT3患者中，z1031前为6.3%，z1031后为7.4% （p=0.02）。与接受初次手术的患者相比，接受NET的患者更有可能发生BCS (46.4% vs 43.9%, p=0.02)，调整后OR为1.60 （95% CI: 1.46-1.75, p<0.001）。. NET的使用自1931年以来增长缓慢，但总体使用仍然很低。NET显著增加激素受体阳性临床T2-4c乳腺癌患者的BCS发生率。临床医生应考虑在激素受体阳性乳腺癌患者对BCS感兴趣时使用NET。
ACOSOG Z1031 demonstrated that neoadjuvant endocrine therapy (NET) increased breast conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2–4c estrogen receptor positive breast cancer. We evaluated national trends in NET use in relation to Z1031 trial conduct and the impact of NET on rates of BCS. Using the National Cancer Data Base (NCDB), we identified all cT2-4c hormone receptor positive breast cancer patients age ≥50 from 2004–2012. Time intervals of pre-Z1031 (2004–2006), during-Z1031 (2007–2009), and post-Z1031 (2010–2012) were examined. Adjusted analyses were performed using multivariable logistic regression. Of 77,272 patients, 2,294 (3.0%) received NET. Clinical T stage distribution was 66,885 (86.6%) cT2, 7,318 (9.5%) cT3, and 3,069 (4.0%) cT4a-c. There was a small but statistically significant increase in NET use from 2.7% pre-Z1031 to 3.2% post-Z1031; the adjusted OR for NET was 1.28 (95% CI: 1.13–1.45, p<0.001) for post-Z1031 versus pre-Z1031. NET use varied by clinical T stage; in cT2 patients, it increased from 1.8% pre-Z1031 to 2.4% post-Z1031 (p<0.001); in cT3 patients from 6.3% pre-Z1031 to 7.4% post-Z1031 (p=0.02). Patients receiving NET were more likely to undergo BCS compared with patients undergoing primary surgery (46.4% vs 43.9%, p=0.02) with adjusted OR 1.60 (95% CI: 1.46–1.75, p<0.001). NET use has increased slowly since Z1031, however overall use remains low. NET significantly increased rates of BCS in patients with hormone receptor positive clinical T2-4c breast cancer. Clinicians should consider NET use for patients with hormone receptor positive breast cancer interested in BCS.