Scholarlink

<p>ER+/PR−/HER2 − breast cancer is a subtype of hormone receptor-positive breast cancer characterized by distinct biological behavior. To evaluate the real-world effectiveness of neoadjuvant chemotherapy (NACT) versus adjuvant chemotherapy (ACT) in this subtype, we conducted a retrospective study comparing the prognostic impact of the two treatment strategies. We extracted cases diagnosed between 2010 and 2021 from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was employed to control for confounding factors, and breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the two groups. Multiple machine learning models, including XGBoost, were developed based on clinicopathological parameters to predict 1-, 3-, and 5-year OS rates. A total of 78,693 patients with ER+/HER2 − breast cancer were included, among whom 9,742 had the ER+/PR− subtype. After PSM, 9,627 patients were matched in each of the ER+/PR − and ER+/PR+ groups; survival analysis revealed that patients with the ER+/PR− subtype had significantly worse outcomes (both <i>p</i> &lt; 0.001). Further matching of the NACT and ACT groups within the ER+/PR− subtype (406 patients per group) showed that patients in the ACT group had significantly superior OS and BCSS compared with those in the NACT group (HR = 1.42 and 1.54, respectively; both <i>p</i> &lt; 0.01), an adverse association confirmed by competing risks analysis (SHR = 1.59). Although the NACT group achieved a higher pathological complete response rate (1.7% vs. 0.3%), this did not translate into a survival advantage at the population level. The XGBoost model demonstrated the best predictive performance, with AUCs ranging from 0.821 to 0.866. In conclusion, in ER+/PR−/HER2 − breast cancer, postoperative adjuvant chemotherapy is associated with superior survival outcomes compared with preoperative neoadjuvant chemotherapy, suggesting that neoadjuvant chemotherapy may not be the preferred strategy.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Impact of neoadjuvant and adjuvant chemotherapy on the prognosis of ER+/PR−/HER2− breast cancer in a propensity score–matched study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月3日

查看全文
  • Mingyan Gong,
  • Ran Ju,
  • Xurui Zhang,
  • Aidi Zhang,
  • Xingcong Ma,
  • Wanjun Yan,
  • Jingkun Qu,
  • Fei Wu,
  • Shuqun Zhang,
  • Chong Du

摘要

ER+/PR−/HER2 − breast cancer is a subtype of hormone receptor-positive breast cancer characterized by distinct biological behavior. To evaluate the real-world effectiveness of neoadjuvant chemotherapy (NACT) versus adjuvant chemotherapy (ACT) in this subtype, we conducted a retrospective study comparing the prognostic impact of the two treatment strategies. We extracted cases diagnosed between 2010 and 2021 from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was employed to control for confounding factors, and breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the two groups. Multiple machine learning models, including XGBoost, were developed based on clinicopathological parameters to predict 1-, 3-, and 5-year OS rates. A total of 78,693 patients with ER+/HER2 − breast cancer were included, among whom 9,742 had the ER+/PR− subtype. After PSM, 9,627 patients were matched in each of the ER+/PR − and ER+/PR+ groups; survival analysis revealed that patients with the ER+/PR− subtype had significantly worse outcomes (both p < 0.001). Further matching of the NACT and ACT groups within the ER+/PR− subtype (406 patients per group) showed that patients in the ACT group had significantly superior OS and BCSS compared with those in the NACT group (HR = 1.42 and 1.54, respectively; both p < 0.01), an adverse association confirmed by competing risks analysis (SHR = 1.59). Although the NACT group achieved a higher pathological complete response rate (1.7% vs. 0.3%), this did not translate into a survival advantage at the population level. The XGBoost model demonstrated the best predictive performance, with AUCs ranging from 0.821 to 0.866. In conclusion, in ER+/PR−/HER2 − breast cancer, postoperative adjuvant chemotherapy is associated with superior survival outcomes compared with preoperative neoadjuvant chemotherapy, suggesting that neoadjuvant chemotherapy may not be the preferred strategy.