Artigo

Survival outcomes of neoadjuvant versus adjuvant therapy in patients with T1c, node‐negative, human epidermal growth factor receptor 2–positive breast cancer: A Surveillance, Epidemiology, and End Results population‐based study

Autor(es): Xuelian Wang MD1 | Yuhang Shang MMed1 | Jiayang Zhang MD2 | Jiangwei Liu MMed1 | Zhengbo Fang MMed1 | Yansong Liu MD1 | Weilun Cheng PhD1 | Yunqiang Duan MD1 | Anbang Hu MMed1 | Jiarui Zhang MMed1 | Mingcui Li MMed1 | Yanling Li MMed1 | Hanyu Zhang MMed1 | Zhiyuan Rong MMed1 | Suborna S. Shakila MMed1 | Fanjing Kong MMed1 | Baoliang Guo PhD1

ABSTRACT

Background: Persistent debates exist regarding the superiority of neoadjuvant therapy (NAT) over adjuvant therapy (AT) for patients with T1c, node‐negative, human epidermal growth factor receptor 2–positive (HER2þ) breast cancer, and relevant guidelines for these patients are lacking.

Methods: Data on patients with T1cN0M0‐stage HER2þ breast cancer who received chemotherapy and surgery were extracted from 2010 to 2020 from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to create well‐balanced cohorts for the NAT and AT groups. Kaplan–Meier (KM) analysis and Cox proportional hazards models were used to assess the differences between NAT and AT in terms of overall survival (OS) and breast cancer–specific survival (BCSS). Additionally, logistic regression models were used to explore factors associated with response to NAT.

Results: After PSM, 2140 patient pairs were successfully matched, which achieved a balanced distribution between the NAT and AT groups. KM curves revealed similar OS and BCSS between patients receiving NAT and those undergoing AT. A multivariate Cox model identified achieving pathological complete response (pCR) after NAT, compared with AT, as a protective prognostic factor for OS (hazard ratio, 0.52; 95% CI, 0.35–0.77; p < .001) and BCSS (hazard ratio, 0.60; 95% CI, 0.37–0.98; p = .041). A logistic regression model revealed that White race and hormone receptor–negative status independently predicted pCR.

Conclusions: For patients with T1cN0M0‐stage HER2þ breast cancer, NAT demonstrated comparable OS and BCSS to AT. Patients who achieved pCR after NAT exhibited significantly better survival outcomes compared with those who received AT.

Keywords: early‐stage breast cancer, human epidermal growth factor receptor 2–positive (HER2þ), neoadjuvant therapy, Surveillance, Epidemiology, and End Results (SEER), survival outcomes

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19/08/2024

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