05.31 梅奧大數據分析乳腺癌新輔助化療

對於有指徵的乳腺癌患者，雖然既往大多通過手術、術後輔助化療和放療進行治療，但是術前新輔助化療的使用正在不斷增加；不過，對於各種生物學亞型乳腺癌的新輔助化療使用趨勢，此前尚無評價。美國規模最大的綜合醫學中心、最近兩年連續榮登美國最佳醫院排名榜首的梅奧醫學中心對此進行了大數據分析。

2018年5月21日，美國乳腺外科醫師學會和腫瘤外科學會《腫瘤外科學年鑑》在線發表梅奧醫學中心的研究報告，評價了新輔助化療用於不同生物學亞型乳腺癌的時間變化趨勢。

該研究根據美國外科醫師學會和美國癌症學會的全國癌症數據庫，確定2010年1月～2015年12月接受根治手術並且進行化療的所有浸潤性乳腺癌年齡≥18歲患者共31萬5264例，根據不同的激素受體（HR）和人表皮生長因子受體2（HER2）狀態進行分層，通過趨勢檢驗進行時間比例趨勢分析。

結果發現，接受輔助化療、新輔助化療的患者分別為25萬1726例（79.8%）、6萬3538例（20.2%）。

2010～2015年，所有生物學亞型乳腺癌的新輔助化療比例顯著增加（P<0.001）

• HR陰性HER2陰性（19.5%～33.7%）
• HR陰性HER2陽性（21.5%～39.8%）
• HR陽性HER2陽性（17.0%～33.7%）
• HR陽性HER2陰性（13.0%～16.8%）近年來顯著少於其他亞型（P<0.001）

因此，對於接受化療的乳腺癌患者，所有生物學亞型的新輔助化療均有增加。三陰性乳腺癌和HER2陽性乳腺癌的新輔助化療使用率最高，這些亞組的新輔助化療使用率為HR陽性HER2陰性乳腺癌的兩倍。

Ann Surg Oncol. 2018 May 21. [Epub ahead of print]

Neoadjuvant Chemotherapy Use in Breast Cancer is Greatest in Excellent Responders: Triple-Negative and HER2+ Subtypes.

Brittany L. Murphy, Courtney N. Day, Tanya L. Hoskin, Elizabeth B. Habermann, Judy C. Boughey.

Mayo Clinic, Rochester, USA.

BACKGROUND: While breast cancer has historically been treated with surgery followed by adjuvant chemotherapy (AC) and radiation when indicated, neoadjuvant chemotherapy (NAC) use is thought to be increasing; however, the trends of its use in various biological subtypes have not been evaluated. We sought to evaluate the trend of NAC use over time by biological subtype.

METHODS: We identified all patients with invasive breast cancer who underwent curative intent surgery and were treated with chemotherapy from 2010 to 2015 from the National Cancer Database. An unadjusted analysis of trends in proportions over time was performed using Cochran-Armitage trend tests stratified by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status.

RESULTS: Of 315,264 patients who received chemotherapy, 251,726 (79.8%) received AC and 63,538 (20.2%) received NAC. From 2010 to 2015, significant increases in NAC use were seen in all biologic subtypes (all p<0.001). The highest proportions and greatest increases in proportions of NAC were seen among triple-negative breast cancers (TNBC; 19.5-33.7%) and HER2+ (HR-/HER2+, 21.5-39.8%; HR+/HER2+, 17.0-33.7%) tumors. HR+/HER2- tumors also had a statistically significant increase in use but this increase was less dramatic (13.0-16.8%) and NAC use in recent years was significantly lower than in other subtypes (p<0.001).

CONCLUSION: Within patients receiving chemotherapy for breast cancer, its receipt in the neoadjuvant setting has been increasing among all biologic subtypes. The highest use of NAC is in TNBC and HER2+ disease, with use in these subgroups being twice as frequent as in HR+/HER2- disease.

DOI: 10.1245/s10434-018-6531-5