放射治疗在吡咯替尼治疗转移性HER2过表达乳腺癌中的价值  

Value of radiotherapy in metastatic HER2-overexpressing breast cancer treated with pyrotinib

作　　者：孙楠 孙祥露 刘静 杨燕 周咏春 Sun Nan;Sun Xianglu;Liu Jing;Yang Yan;Zhou Yongchun(Department of Radiation Oncology,First Affiliated Hospital of Bengbu Medical University,Bengbu 233000,China;Department of Medical Oncology,First Affiliated Hospital of Bengbu Medical University,Bengbu 233000,China;Anhui Province Key Laboratory of Respiratory Tumor and Infectious Disease,Bengbu Medical University,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学第一附属医院肿瘤放疗科,蚌埠233000 [2]蚌埠医科大学第一附属医院肿瘤内科,蚌埠233000 [3]安徽省呼吸系统肿瘤与感染性疾病重点实验室,蚌埠233000

出　　处：《中华放射医学与防护杂志》2025年第3期183-187,共5页Chinese Journal of Radiological Medicine and Protection

基　　金：安徽高校自然科学研究重点项目(2023AH051978);蚌埠医学院第一附属医院高水平科技创新团队基金(BYYFY2022TD003)。

摘　　要：目的探讨放射治疗在吡咯替尼治疗术后转移性人表皮生长因子受体2(HER2)过表达乳腺癌中的疗效,并探寻可能获益的亚组人群。方法回顾性连续选取2018年1月至2022年7月于蚌埠医科大学第一附属医院接受吡咯替尼治疗的术后远处转移的187例HER2过表达乳腺癌患者的临床资料,应用Kaplan-Meier法观察放射治疗患者生存结局的变化;通过单因素和多因素分析,明确预后影响因素;利用Log-rank检验寻找放射治疗潜在获益的亚组人群。结果纳入分析的187名患者中,有76人接受了放射治疗,总人群的中位随访时间为16.9(3.1~37.9)个月,2年总生存率(OS)为75.0%。多因素分析结果显示,年龄、转移状态、放射治疗是影响OS的独立因素(χ2=3.86~6.76,P<0.05)。进一步亚组分析提示,放射治疗能够明显改善年龄≥50岁、寡转移、骨转移、未接受内分泌治疗及曲妥珠单抗耐药人群的OS(P<0.05)。结论在吡咯替尼治疗的基础上,放射治疗可进一步提高术后转移性HER2过表达乳腺癌的生存率;其中,在肿瘤负荷低、系统治疗不足和耐药人群中,放射治疗改善预后的作用可能更明显。Objective To investigate the efficacy of radiotherapy in postoperative metastatic human epidermal growth factor receptor 2(HER2)-overexpressing breast cancer treated with pyrotinib,and to identify potential subgroups that may benefit from this strategy.Methods The clinical data of 187 patients with postoperative distant metastatic HER2-overexpressing breast cancer who received pyrotinib at the First Affiliated Hospital of Bengbu Medical University from January 2018 to July 2022 were retrospectively analyzed.The Kaplan-Meier method was used to assess changes in survival outcomes in patients undergoing radiotherapy.Univariate and multivariate analyses were conducted to identify prognostic factors,and the log-rank test was used to determine potential subgroups that may benefit from radiotherapy.Results Among the 187 patients,76 received radiotherapy.The median follow-up duration for the entire population was 16.9 months(range:3.1-37.9 months),and the 2-year overall survival(OS)was 75.0%.Multivariate analysis showed that age,metastatic status,and radiotherapy were independent factors affecting OS(3.86-6.76,P<0.05).Further subgroup analysis showed that radiotherapy significantly improved OS in patients aged≥50 years,those with oligometastases or bone metastases,those not receiving endocrine therapy,and those resistant to trastuzumab(P<0.05).Conclusions Radiotherapy,in addition to pyrotinib,can enhance the survival rate of patients with postoperative metastatic HER2-overexpressing breast cancer.The benefits of radiotherapy may be more pronounced in patients with a low tumor burden,inadequate systemic treatment,and drug resistance.

关 键 词：转移性乳腺癌 人表皮生长因子受体2 放射治疗 吡咯替尼 

分 类 号：R73[医药卫生—肿瘤]