HR+/HER-2+晚期乳腺癌一线维持治疗的疗效分析

The efficacy of first-line maintenance therapy in HR+/HER-2+advanced breast cancer

目的探讨激素受体阳性(HR+)/人表皮生长因子受体2阳性(HER-2+)的晚期乳腺癌患者经一线治疗达到疾病控制后,维持治疗与否对总生存期(OS)的影响。方法收集1999年1月1日至2018年3月1日HR+/HER-2+晚期乳腺癌患者的临床病理资料。根据一线治疗结束后是否维持治疗分为无维持治疗组与维持治疗组。生存分析采用Kaplan-Meier法,多因素分析用Cox比例风险模型。结果共纳入HR+/HER-2+乳腺癌患者84例,维持治疗组65例(77.4%),无维持治疗组19例(22.6%),两组中位OS分别为53.8个月和28.6个月,差异有统计学意义(P=0.015)。Cox多因素分析显示,一线维持治疗是影响HR+/HER-2+晚期乳腺癌患者OS的独立因素(HR=0.456,95%CI:0.238~0.873,P=0.018)。维持治疗组中,接受单纯靶向治疗、单纯内分泌治疗、单纯化疗、靶向联合化疗与靶向联合内分泌治疗的患者分别为15例、10例、6例、13例和21例,中位OS分别为37.0个月、未达到、45.9个月、53.8个月和90.3个月。5个维持治疗亚组中位OS的差异有统计学意义(P=0.026)。与无维持治疗组比较,靶向联合内分泌治疗和单纯内分泌治疗可显著延长HR+/HER-2+晚期乳腺癌患者的中位OS(P=0.005,P=0.023)。结论HR+/HER-2+晚期乳腺癌患者经一线治疗达到疾病控制后,接受维持治疗可延长生存。

Objective To evaluate the effect of first-line maintenance therapy on overall survival(OS)in patients with hormone receptor positive(HR+)and human epidermal growth factor receptor 2 positive(HER-2+)advanced breast cancer.Methods From January 11999 to March 12018,patients with HR+/HER-2+advanced breast cancer were enrolled.According to whether accepted maintenance treatment after first-line treatment,patients were divided into non-maintenance treatment group or maintenance treatment group.Survival data were analyzed by Kaplan-Meier curves and Cox proportional risk model.Results A total of 84 patients were enrolled,including 65 patients(77.4%)in maintenance group and 19 patients(22.6%)in non-maintenance group.The median OS of maintenance group and non-maintenance group was 53.8 months and 28.6 months respectively(P=0.015).Cox regression model showed that the first-line maintenance treatment was an independent factor affecting OS of patients with HR+/HER-2+advanced breast cancer(HR=0.456,95%CI:0.238-0.873,P=0.018).In maintenance group,there were 15,10,6,13 and 21 cases receiving target therapy,endocrine therapy,chemotherapy,target combined chemotherapy and target combined endocrine therapy,respectively,and the median OS of them were 37.0,unachieved,45.9,53.8 and 90.3 months,respectively.The difference among the 5 groups had statistical significance(P=0.026).Compared with non-maintenance group,target combined endocrine therapy and endocrine therapy could significantly benefit the OS of patients with HR+/HER-2+advanced breast cancer(P=0.005,P=0.023).Conclusion After first-line treatment for HR+/HER-2+advanced breast cancer patients with controlled disease,maintenance therapy can prolong survival.