Preoperative Systemic Therapy Versus Upfront Surgery in HER2-Positive Breast Cancer in the Real World

Xingfei Yu, Chen Wang, Yabing Zheng, Beibei Miao, Jiejie Hu, Xiying Shao, Liming Sheng, Juan Lin, Yuqin Ding, Haojun Xuan, Yingying Ding, Lijie Gong, Weiliang Feng, Chengdong Qin, Daobao Chen, Yang Yu, Hongjian Yang, Xingfei Yu, Chen Wang, Yabing Zheng, Beibei Miao, Jiejie Hu, Xiying Shao, Liming Sheng, Juan Lin, Yuqin Ding, Haojun Xuan, Yingying Ding, Lijie Gong, Weiliang Feng, Chengdong Qin, Daobao Chen, Yang Yu, Hongjian Yang

Abstract

Purpose: To compare survival in different strategies, preoperative systemic treatment versus upfront surgery, in HER2-positive early breast cancer patients in the real world.

Methods: According to the actual upfront treatment, eligible patients from 2012 to 2015 were classified as preoperative systemic treatment or upfront surgery group prospectively. The primary endpoint is disease-free survival; the second endpoint is overall survival. All the outcomes were examined in the propensity score matching model and inverse probability of treatment weighting model.

Results: Included in the analysis were 1,067 patients (215 in the preoperative systemic treatment group, 852 in the upfront surgery group). In the propensity score matching model (matching at 1:1 ratio), the disease-free survival of the preoperative systemic treatment group was significantly higher than that of the upfront surgery group (hazard ratio, 0.572, 95%CI, 0.371-0.881, P, 0.012). In the inverse probability of treatment weighting model, there was no significant difference in disease-free survival between the two groups (hazard ratio, 0.946, 95%CI, 0.763-1.172, P, 0.609). For overall survival, there was no significant difference between the two groups.

Conclusion: The HER2-positive patients who accepted preoperative systemic treatment had better disease-free survival than those who underwent upfront surgery by real-world statistic methods.

Clinical trial registration: Clinicaltrials.gov, identifier NCT04249440.

Keywords: breast cancer; human epidermal growth factor receptor 2; preoperative systemic treatment; real world; surgery.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.​​

Copyright © 2021 Yu, Wang, Zheng, Miao, Hu, Shao, Sheng, Lin, Ding, Xuan, Ding, Gong, Feng, Qin, Chen, Yu and Yang.

Figures

Figure 1
Figure 1
Flow diagram of participants with operable HER2-positive breast cancer.
Figure 2
Figure 2
The DFS and OS of preoperative systemic treatment (PST) group and upfront surgery (US) group in primary unmatched model (A, B) in propensity score matching (PSM) model (C, D), in inverse probability of treatment weighting (IPTW) model (E, F).
Figure 3
Figure 3
The stratified analysis of DFS and OS according to pathological response status in the PST group in primary unmatched model (A, B) in propensity score matching (PSM) model (C, D), in inverse probability of treatment weighting (IPTW) model (E, F).
Figure 4
Figure 4
Distribution cone diagram of propensity score in two groups in unmatched model (A), in propensity score matching (PSM) model (B), in inverse probability of treatment weighting (IPTW) model (C).

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