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中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 245 -251. doi: 10.3877/cma.j.issn.1674-0793.2026.04.005

论著

ESR1异常晚期乳腺癌患者临床特征、分子特征及治疗结局的真实世界研究
赖宏娜, 陈茂剑, 罗思敏, 丁林潇潇()   
  1. 510120 广州,中山大学孙逸仙纪念医院乳腺肿瘤中心
  • 收稿日期:2026-06-11 出版日期:2026-08-01
  • 通信作者: 丁林潇潇
  • 基金资助:
    国家自然科学基金青年项目(8220314182003176); 广州市基础与应用基础研究计划及企业联合资助项目(2023A03J0720)

Real-world study of clinical characteristics, molecular features and treatment outcomes in patients with ESR1-altered advanced breast cancer

Hongna Lai, Maojian Chen, Simin Luo, Xiaoxiao Dinglin()   

  1. Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • Received:2026-06-11 Published:2026-08-01
  • Corresponding author: Xiaoxiao Dinglin
引用本文:

赖宏娜, 陈茂剑, 罗思敏, 丁林潇潇. ESR1异常晚期乳腺癌患者临床特征、分子特征及治疗结局的真实世界研究[J/OL]. 中华普通外科学文献(电子版), 2026, 20(04): 245-251.

Hongna Lai, Maojian Chen, Simin Luo, Xiaoxiao Dinglin. Real-world study of clinical characteristics, molecular features and treatment outcomes in patients with ESR1-altered advanced breast cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(04): 245-251.

目的

分析雌激素受体基因ESR1异常晚期乳腺癌患者的临床特征、分子特征、ESR1异常检出后的治疗模式及无进展生存(PFS)影响因素,为内分泌耐药后个体化治疗决策提供真实世界依据。

方法

回顾性收集中山大学孙逸仙纪念医院乳腺肿瘤中心2019年1月至2025年1月经分子检测确认存在ESR1异常(包括点突变、扩增、重排及其他ESR1相关异常)的晚期乳腺癌患者资料。根据最新建库表提取年龄、无病生存(DFS)、复发状态、转移部位、既往CDK4/6抑制剂暴露(包括使用时间及线数)、既往治疗线数、ESR1多克隆突变、PIK3CA/TP53共突变、肿瘤突变负荷(TMB)等信息,根据ESR1异常检出后的下一线治疗方案进行分组。采用Kaplan-Meier法估计PFS,采用Cox比例风险模型探索性分析PFS相关因素。

结果

共纳入36例患者,Kaplan-Meier估计中位真实世界无进展生存(rwPFS)期为9.0个月(95% CI:4.0~12.0个月)。单因素Cox回归分析显示,既往CDK4/6抑制剂暴露与较短PFS相关(HR=2.47,95% CI:1.12~5.44,P=0.025),骨转移与较短PFS呈边缘相关趋势(HR=1.88,95% CI:0.90~3.97,P=0.095)。多因素探索性模型显示,骨转移(调整HR=2.35,95% CI:1.08~5.11,P=0.030)和既往CDK4/6抑制剂暴露(调整HR=3.11,95% CI:1.35~7.14,P=0.008)与较短PFS相关。治疗分组间rwPFS差异无统计学意义(log-rank P=0.584)。

结论

ESR1异常晚期乳腺癌患者具有明显临床及分子异质性。骨转移和既往CDK4/6抑制剂暴露可能与ESR1异常检出后较短PFS相关,后续治疗策略仍需结合转移负荷、既往治疗暴露及分子特征进行综合判断。

Objective

To investigate the clinicogenomic characteristics, post-ESR1 alteration treatment patterns and prognostic factors for progression-free survival (PFS) in patients with ESR1-altered advanced breast cancer in a real-world cohort.

Methods

From January 2019 to January 2025, the clinicopathological and molecular data were retrospectively collected from patients with ESR1 alterations (including point mutations, amplifications, rearrangements and other ESR1-related abnormalities) in advanced breast cancer. Variables included age, disease-free survival (DFS), recurrence status, metastasis site, prior CDK4/6 inhibitor exposure (duration and lines of therapy), PIK3CA/TP53 co-mutations, tumor mutation burden (TMB) and post-ESR1 alteration treatment groups. Kaplan-Meier analysis was used to estimate PFS. Univariate and multivariable Cox proportional hazards models were used to identify variables associated with PFS exploratively.

Results

A total of 36 patients were included in the analysis. The median real-world progression-free survival (rwPFS) was 9.0 months (95% CI: 4.0-12.0 months). In the univariate Cox regression, prior CDK4/6 inhibitor exposure was associated with shorter PFS (HR=2.47, 95% CI: 1.12-5.44, P=0.025), and bone metastasis showed a borderline association with shorter PFS (HR=1.88, 95% CI: 0.90-3.97, P=0.095). In the exploratory multivariate model, bone metastasis (adjusted HR=2.35, 95% CI: 1.08-5.11, P=0.030) and prior CDK4/6 inhibitor exposure (adjusted HR=3.11, 95% CI: 1.35-7.14, P=0.008) were associated with shorter PFS. No significant difference was observed among treatment groups (log-rank P=0.584).

Conclusions

ESR1-altered advanced breast cancer shows substantial clinical and molecular heterogeneity. This study suggests that bone metastasis and prior CDK4/6 inhibitor exposure may be associated with shorter PFS after detection of ESR1 alterations. The subsequent treatment strategy needs to be comprehensively judged in combination with transfer burden, prior treatment exposure and molecular features.

表1 ESR1异常晚期乳腺癌患者主要临床及分子特征
表2 ESR1异常位点及类型分布
表3 ESR1异常晚期乳腺癌患者PFS影响因素的单因素Cox回归分析
图1 单因素及多因素Cox回归探索性模型森林图
图2 总体真实世界无进展生存期(rwPFS)的Kaplan-Meier曲线 中位无进展生存期为11.0个月,95% CI:6.5~15.5个月
图3 按治疗策略分组的真实世界无进展生存期(rwPFS)Kaplan-Meier曲线 CDK4/6抑制剂联合内分泌治疗组(CDK4/6i+ET);SERD相关治疗组(SERD-related);化疗组(Chemo)
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