Impact of ovarian function suppression on prognosis in premenopausal patients with HR+/HER2 + early-stage breast cancer: a multi-center retrospective study

Abstract

Background: The impact of adjuvant ovarian function suppression (OFS) in premenopausal patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-positive (HER2+) breast cancer remains unclear. The study aims to evaluate the value of OFS for patients with HR+/HER2 + early-stage breast cancer treated with trastuzumab. Methods: Kaplan-Meier curves and the log-rank test were used to compare disease-free survival (DFS). Univariate and multivariate Cox regression analyses were performed to identify significant prognostic factors. Multivariable logistic regression model was used to predict the utilization of OFS. Results: A total of 1,338 patients from multiple centers were enrolled, including 570 who received OFS treatment. Patients treated with selective estrogen receptor modulators (SERM) or aromatase inhibitors (AI) plus OFS as adjuvant endocrine therapy showed significantly better DFS compared to those who received SERM alone (HR = 0.496; 95% CI: 0.307–0.803; p = 0.004). Univariate and multivariate Cox regression analysis further confirmed that receiving SERM/AI plus OFS as adjuvant endocrine therapy was an independent prognostic factor in HR+/HER2 + early-stage breast cancer patients. Subgroup analysis indicated that patients with estrogen-receptor (ER) expression below 50%, histological grade 3, tumors larger than 2 cm, or lymph node-positive could benefit from OFS. In addition, age<35 years, nodal involvement, histological grade 3 and ER expression below 50% were more likely to receive OFS compared with control group. Conclusion: Our study confirms that premenopausal patients with HR+/HER2 + early-stage breast cancer could benefit from additional OFS after trastuzumab treatment.