内分泌治疗缺失在雌激素受体-低 (1%-10%) 早期乳腺癌
Grace M Choong1, Tanya L Hoskin2, Judy C Boughey3
1Department of Oncology, Mayo Clinic, Rochester, MN.
概括
辅助内分泌疗法 (ET) 遗漏与低雌激素受体 (ER-low) 早期乳腺癌 (BC) 的生存率较差有关. 在接受新辅助化疗后残留疾病和较高ER水平的患者中,风险更高.
科学领域:
- 在瘤学瘤学.
- 乳腺癌研究研究 乳腺癌研究
- 内分泌治疗疗法 内分泌治疗疗法
背景情况:
- 辅助内分泌疗法 (ET) 是雌激素受体阳性 (ER +) 早期乳腺癌 (BC) 的标准,改善整体存活率 (OS).
- 在ER低BC (ER1%-10%) 的患者中ET的疗效仍然不确定,需要进一步调查.
研究的目的:
- 评估ET缺失对高风险,低ER早期BC患者的OS的影响.
- 为了确定ER-lowBC人口中的患者亚组,他们可能从ET中受益最多或最少.
主要方法:
- 对接受 (新) 辅助化疗的I-III期ER-lowBC患者国家癌症数据库的分析.
- 使用时间依赖的考克斯比例危险回归来分析OS,以ET启动为共变量.
主要成果:
- 在7018名符合条件的患者中,42%的人在12个月内省略了ET. 在孕激素受体阴性,HER2阴性,高度瘤,高基-67和接受新辅助化疗的患者中,ET遗漏更频繁.
- ET遗漏与死亡风险显著增加有关 (HR,1.23;P = .02).
- 在ER6%-10% (HR, 1.42) 的患者中,ET遗漏的负面影响比ER1%-5% (HR, 1.15) 的患者更为明显. 在接受新辅助化疗的患者中,ET遗漏在残留疾病患者中恶化了OS (HR,1.26).
结论:
- 在ER低的早期BC中省略ET与显著更糟糕的OS有关.
- 经过新辅助化疗后残留疾病的患者和ER水平较高的患者 (6%-10%) 似乎在ET遗漏的情况下存在更大的生存劣势.
- 在有前性数据出现之前,应告知ER-lowBC患者ET的潜在生存益处.
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