Adjuvant trastuzumab reduces locoregional recurrence in women who underwent mastectomy without radiation therapy for HER-2-positive breast cancer:a retrospective analysis with propensity score matching
Jing Hao, Wang Shulian, Tang Yu, Song Yongwen, Fang Hui, Wang Jianyang, Zhang Jianghu, Jin Jing, Liu Yueping, Qi Shunan, Tang Yuan, Li Ning, Chen Bo, Lu Ningning, Li Yexiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021,China
Abstract：Objective To investigate the locoregional benefit from adjuvant anti-HER-2 target therapy and the possibility of omitting postmastectomy radiation therapy (PMRT) in HER-2 positive breast cancer patients. Methods Clinical data of 1398 patients diagnosed with HER-2+ breast cancer admitted to our hospital who underwent mastectomy without PMRT from 2009 to 2014 were retrospectively analyzed, and 370 of them received adjuvant anti-HER-2 target therapy mainly with trastuzumab. Results Anti-HER-2 target therapy significantly improved the disease-free survival (DFS) and overall survival (OS), whereas reduced the locoregional recurrence (LRR) insignificantly. Multivariate analysis demonstrated that anti-HER-2 target therapy improved the locoregional recurrence-free survival (LRRFS)(P=0.06). After propensity score matching,the 5-year LRR rate was 4.4% vs. 6.4%(P=0.070) for those treated with and without anti-HER-2 target therapy. Subgroup analysis revealed that the locoregional control benefit was only significant in patients with pathological Grade Ⅰ-Ⅱtumors (2.5% vs. 5.9%,P=0.046). For patients with pN1 tumors with and without anti-HER-2 target therapy,the 5-year LRR rate was 8.2% vs. 12.3%(P=0.150). Patients with hormone receptor-positive tumors obtained significant benefit from anti-HER-2 target therapy. The 5-year LRR rate could be less than 5% in patients with favorable risk factors who received anti-HER-2 target therapy. Conclusions Anti-HER-2 target therapy with trastuzumab can improve the LRRFS of patients with HER-2+ breast cancer after mastectomy. Nevertheless, patients with radiotherapy indications have to receive radiotherapy due to relatively high recurrence rate. Newly approved dual HER-2 blockade is a promising approach to further reduce LRR. Subgroup analysis is required to identify the low-risk patients.
Jing Hao,Wang Shulian,Tang Yu et al. Adjuvant trastuzumab reduces locoregional recurrence in women who underwent mastectomy without radiation therapy for HER-2-positive breast cancer:a retrospective analysis with propensity score matching[J]. Chinese Journal of Radiation Oncology, 2019, 28(11): 830-835.
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2019, Vol. 28 
