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| 双靶联合放疗在HER-2阳性乳腺癌保乳术后的应用 |
| Application of dual-target combined massive fractionated radiotherapy in patients with breast-conserving surgery for HER-2 positive breast cancer |
| 投稿时间：2025-05-27 |
| DOI：10.3969/j.issn.1000-0399.2026.03.006 |
| 中文关键词: 双靶 大分割放疗 人表皮生长因子受体-2阳性 乳腺癌 保乳术 倾向性评分匹配法 |
| 英文关键词: Dual targets Massive fractionated radiotherapy Positive for human epidermal growth factor receptor-2 Breast cancer Breast-conserving surgery Propensity score matching method |
| 基金项目:河北省医学科学研究课题计划项目(编号:20241167) |
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| 摘要点击次数: 632 |
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| 中文摘要: |
| 目的 基于倾向性评分匹配法（PSM）分析双靶联合大分割放疗在人表皮生长因子受体-2（HER-2）阳性乳腺癌患者保乳术后中的应用。方法 回顾性分析唐山市人民医院放化六科2021年12月至2024年6月132例行保乳术及术后辅助治疗的HER-2阳性乳腺癌患者的临床资料，采用PSM按1∶1最近邻匹配法匹配，匹配后双靶组（双靶联合大分割放疗）和单靶组（单靶联合大分割放疗）各46例患者。比较两组患者血清多肽特异性抗原（TPS）、糖类抗原153（CA153）、血管内皮生长因子（VEGF）、VEGF受体2（VEGFR2）水平差异，比较两组患者不良反应发生率及随访情况。结果 相较于治疗前，治疗后6个月两组血清TPS、CA153水平均降低，相较于单靶组，双靶组治疗后6个月血清TPS、CA153水平更低（P<0.05）；相较于治疗前，治疗后6个月两组血清VEGF、VEGFR2水平均降低，相较于单靶组，双靶组治疗后6个月血清VEGF、VEGFR2水平更低（P<0.05）；两组不良反应发生率差异无统计学意义（P>0.05）；双靶组中位随访时间为17.5个月（范围5～35个月），单靶组为17.0个月（范围5～34个月），两组中位随访时间差异无统计学意义（log-rank检验χ2=0.127,P=0.725），具有良好可比性。Kaplan-Meier生存分析显示，双靶组PFS为94.4%高于单靶组的85.2%，差异有统计学意义（log-rank检验χ2=4.795,P=0.029）。随访期间，双靶组未出现死亡事件，而单靶组观察到4例死亡事件，2年总生存期率略低（log-rank检验χ2=2.841,P=0.092）。结论 HER-2阳性乳腺癌患者保乳术后采用双靶联合大分割放疗可以提高无进展生存期，降低血清TPS、CA153、VEGF、VEGFR2水平，临床需根据患者实际病情选择合适的靶向治疗手段。 |
| 英文摘要: |
| Objective To analyze the application of dual-target combined massive fractionated radiotherapy in breast-conserving surgery for patients with human epidermal growth factor receptor-2（HER-2）-positive breast cancer based on propensity score matching（PSM） method. Methods A retrospective analysis was conducted on the clinical data of 132 patients with HER-2 positive breast cancer who underwent breast-saving surgery and postoperative adjuvant therapy in Department of Radiotherapy and Oncology 6, Tangshan People's Hospital from December 2021 to June 2024. PSM was matched using the 1:1 nearest neighbor matching method. After matching, there were 46 cases in each of the double-target group（double-target combined with massive fractionated radiotherapy） and the single-target group（single-target combined with massive fractionated radiotherapy）. The clinical efficacy differences between the two groups of patients, the levels of serum specific antigen of tumor peptide（TPS）, carbohydrate antigen 153（CA153）, vascular endothelial growth factor（VEGF）, and VEGF receptor 2（VEGFR2）, and the incidence of adverse reactions and the follow-up situation were compared between the two groups of patients. Results Compared with baseline, serum TPS and CA15-3 levels decreased at 6 months in both groups; the dual-blockade group had lower TPS and CA15-3 levels than the single-blockade group（P<0.05）. Serum VEGF and VEGFR2 likewise declined at 6 months in both groups, with greater reductions in the dual-blockade group（P<0.05）. The incidence of adverse events did not differ significantly between groups（P>0.05）. As of December 31, 2024, 132 postoperative HER2-positive breast cancer patients were included. Median follow-up was 17.5 months（range, 5～35） in the dual-blockade group and 17.0 months（5～34） in the single-blockade group, with no significant difference in follow-up duration（Log-rank χ2=0.127,P=0.725）, indicating good comparability. Kaplan – Meier analysis showed a higher 2-year PFS rate in the dual-blockade group（94.4%） than in the single-blockade group（85.2%）(log-rank χ2=4.795, P=0.029). During follow-up, no deaths occurred in the dual-blockade group, whereas four deaths were observed in the single-blockade group, yielding a slightly lower 2-year OS（log-rank χ2=2.841, P=0.092）. Conclusion In HER2-positive breast cancer patients after breast-conserving surgery, dual HER2 blockade combined with hypofractionated radiotherapy improves progression-free survival and produces greater reductions in serum TPS, CA15-3, VEGF, and VEGFR2 than single blockade. Selection of targeted therapy should be individualized according to patient risk and clinical context. |
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