PDF(Pubmed)
Abstract：
OBJECTIVE: To assess the efficacy of neoadjuvant endocrine therapy in female HR-positive/HER2-negative breast cancer patients.
METHODS: We identified female patients aged ≥18 years with cT1-4N0-XM0, HR(+), and HER2(-) breast cancer from the National Cancer Database. The patients who underwent surgery first were categorized as \"surgery-first,\" while those who received NET before surgery were classified as \"NET.\" Propensity score-matching, Cox proportional-hazard model, variance inflation factors, and interaction analysis were employed to estimate the correlation between NET and survival outcomes.
RESULTS: Among 432,387 cases, 2914 NET patients and 2914 surgery-first patients were matched. Compared with the surgery-first group, the NET group received less adjuvant chemotherapy (p < 0.001). Furthermore, the NET group exhibited higher survival probabilities compared with the surgery-first group (3 years: 91.4% vs. 82.1%; 5 years: 82.1% vs. 66.8%). Multivariate Cox analysis indicated that NET was associated with improved OS (surgery-first vs. NET: HR 2.17, 95% CI: 1.93-2.44). Age over 55 years old, having public insurance, higher CDCC score, higher NSBR grade, ER(+)PR(-), and advanced clinical stage were related to worse OS (all p < 0.05). There was an interaction between age, race, income, and home and treatment regimen (all p < 0.05).
CONCLUSIONS: NET may be a more effective treatment procedure than surgery-first in female HR-positive/HER2-negative, non-metastatic breast cancer patients. Future clinical studies with more detailed data will provide higher-level evidence-based data.
METHODS: We identified female patients aged ≥18 years with cT1-4N0-XM0, HR(+), and HER2(-) breast cancer from the National Cancer Database. The patients who underwent surgery first were categorized as \"surgery-first,\" while those who received NET before surgery were classified as \"NET.\" Propensity score-matching, Cox proportional-hazard model, variance inflation factors, and interaction analysis were employed to estimate the correlation between NET and survival outcomes.
RESULTS: Among 432,387 cases, 2914 NET patients and 2914 surgery-first patients were matched. Compared with the surgery-first group, the NET group received less adjuvant chemotherapy (p < 0.001). Furthermore, the NET group exhibited higher survival probabilities compared with the surgery-first group (3 years: 91.4% vs. 82.1%; 5 years: 82.1% vs. 66.8%). Multivariate Cox analysis indicated that NET was associated with improved OS (surgery-first vs. NET: HR 2.17, 95% CI: 1.93-2.44). Age over 55 years old, having public insurance, higher CDCC score, higher NSBR grade, ER(+)PR(-), and advanced clinical stage were related to worse OS (all p < 0.05). There was an interaction between age, race, income, and home and treatment regimen (all p < 0.05).
CONCLUSIONS: NET may be a more effective treatment procedure than surgery-first in female HR-positive/HER2-negative, non-metastatic breast cancer patients. Future clinical studies with more detailed data will provide higher-level evidence-based data.
摘要：
目的：评估新辅助内分泌治疗对女性HR阳性/HER2阴性乳腺癌患者的疗效。
方法：我们确定了年龄≥18岁的cT1-4N0-XM0，HR（），和国家癌症数据库中的HER2（-）乳腺癌。首先接受手术的患者被归类为“首先手术”，而那些在手术前接受NET的人被归类为“NET”。“倾向得分匹配，Cox比例风险模型，方差通货膨胀因素，和交互分析用于估计NET和生存结果之间的相关性。
结果：在432,387例中，2914例NET患者和2914例首次手术患者进行匹配。与第一组手术相比，NET组接受辅助化疗较少(p<0.001)。此外，与手术组相比，NET组的生存概率更高(3年：91.4%vs.82.1%；5年：82.1%vs.66.8%）。多变量Cox分析表明NET与OS改善相关(手术优先与NET：HR2.17，95%CI：1.93-2.44）。年龄超过55岁，有公共保险，更高的CDCC评分，更高的NSBR等级，ER(+)PR(-),晚期临床分期与OS恶化有关(均p<0.05)。年龄之间有相互作用，种族,收入,以及家庭和治疗方案（均p<0.05）。
结论：在HR阳性/HER2阴性的女性患者中，NET可能是比手术优先更有效的治疗方法。非转移性乳腺癌患者。未来具有更详细数据的临床研究将提供更高水平的循证数据。
方法：我们确定了年龄≥18岁的cT1-4N0-XM0，HR（），和国家癌症数据库中的HER2（-）乳腺癌。首先接受手术的患者被归类为“首先手术”，而那些在手术前接受NET的人被归类为“NET”。“倾向得分匹配，Cox比例风险模型，方差通货膨胀因素，和交互分析用于估计NET和生存结果之间的相关性。
结果：在432,387例中，2914例NET患者和2914例首次手术患者进行匹配。与第一组手术相比，NET组接受辅助化疗较少(p<0.001)。此外，与手术组相比，NET组的生存概率更高(3年：91.4%vs.82.1%；5年：82.1%vs.66.8%）。多变量Cox分析表明NET与OS改善相关(手术优先与NET：HR2.17，95%CI：1.93-2.44）。年龄超过55岁，有公共保险，更高的CDCC评分，更高的NSBR等级，ER(+)PR(-),晚期临床分期与OS恶化有关(均p<0.05)。年龄之间有相互作用，种族,收入,以及家庭和治疗方案（均p<0.05）。
结论：在HR阳性/HER2阴性的女性患者中，NET可能是比手术优先更有效的治疗方法。非转移性乳腺癌患者。未来具有更详细数据的临床研究将提供更高水平的循证数据。
