人表皮生长因子受体2阳性乳腺癌术后早期复发转移模式及危险因素

Patterns and risk factors of early recurrence after operation in human epidermal growth factor receptor 2 positive breast cancer undergoing surgery

目的探讨经1年曲妥珠单抗治疗的人表皮生长因子受体2(HER2)阳性乳腺癌术后早期复发转移的模式和影响因素。方法收集139例接受1年曲妥珠单抗辅助治疗的HER2阳性乳腺癌患者的临床资料,分析早期复发(3年内)的时间分布规律和首发部位分布,并分析早期复发的影响因素。结果所有患者中位随访时间为64个月,共有33例发生术后早期复发转移,5例局部复发,28例远处转移,3年无病生存率为76.3%。首次复发转移部位以淋巴结转移(12例)最常见,其次为肺转移(10例)、骨转移(10例)、肝转移(8例)。激素受体阴性患者的早期复发呈双峰曲线,两次高峰分别出现在术后12个月和30个月,而激素受体阳性患者的早期复发呈单峰,出现在术后24个月。年龄≤35岁、组织学分级Ⅲ级、淋巴结转移阳性和孕激素受体(PR)表达<20%是HER2阳性早期乳腺癌预后的独立危险因素。结论HER2阳性乳腺癌术后早期复发存在一定的部位和时间分布规律。尽管使用了1年的曲妥珠单抗,仍有一部分患者被确定为早期复发的高危人群,需要强化抗HER2辅助靶向治疗。

Objective To investigate the patterns and risk factors of early recurrence in human epidermal growth factor receptor 2(HER2) positive breast cancer receiving 1-year trastuzumab. Method The clinical data of 139 patients with HER2 positive breast cancer who received 1-year adjuvant transtuzumab treatment was collected. The time-distribution of early recurrence(within 3 years after surgery) and the distribution of primary recurrence location were analyzed,and the influencing factors of early recurrence were analyzed. Result The median follow-up was 64 months. A total of 33 patients had early recurrence, with 5 cases of local recurrence and 28 cases of distant metastasis. The 3-year disease free survival rate was 76.3%. Lymph node metastasis(12 cases) was the most common site of recurrence and metastasis,followed by lung metastasis(10 cases), bone metastasis(10 cases) and liver metastasis(8 cases). There were two peaks in early recurrence curve of hormone receptor(HR) negative patients, occurred at 12 and 30 months after the operation, respectively, while the early recurrence curve of HR positive patients presented a single peak at 24 months after the operation. Age≤35 years, histological grade Ⅲ, positive lymph node metastasis and progesterone receptor(PR) expression<20% were independent prognostic factors for HER2 positive early breast cancer. Conclusion There were certain regular patterns of site distribution and time distribution for early recurrence of HER2-positive breast cancer after surgery. Although trastuzumab has been used for one year, some patients are still identified as high-risk groups for early recurrence,and need intensive anti-HER2 targeted therapy.