AUTHOR=Yu Xingfei , Wang Chen , Zheng Yabing , Miao Beibei , Hu Jiejie , Shao Xiying , Sheng Liming , Lin Juan , Ding Yuqin , Xuan Haojun , Ding Yingying , Gong Lijie , Feng Weiliang , Qin Chengdong , Chen Daobao , Yu Yang , Yang Hongjian 

TITLE=Preoperative Systemic Therapy Versus Upfront Surgery in HER2-Positive Breast Cancer in the Real World

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.704842

DOI=10.3389/fonc.2021.704842

ISSN=2234-943X

ABSTRACT=Purpose: To compare survival in different strategies, preoperative systemic treatment versus upfront surgery, in HER2-positive early breast cancer patients in the real world.
Methods: According to the actual upfront treatment, eligible patients from 2012 to 2015 were classified as preoperative systemic treatment or upfront surgery group prospectively. The primary endpoint is disease-free survival, the second endpoint is overall survival. All the outcomes were examined in the propensity score matching model and inverse probability of treatment weighting model. 
Results: Finally, 1067 patients (215 in the preoperative systemic treatment group, 852 in the upfront surgery group) were included in the analysis. In the propensity score matching model (matching at 1:1 ratio), the disease-free survival of the preoperative systemic treatment group was significantly higher than that of the upfront surgery group (hazard ratio, 0.57s2, 95%CI, 0.371~0.881, P, 0.012). In the inverse probability of treatment weighting model, there was no significant difference in disease-free survival between the two groups (hazard ratio, 0.946, 95%CI, 0.763~1.172, P, 0.609). For overall survival, there was no significant difference between the two groups.  
Conclusions: The HER2-positive patients accepted preoperative systemic treatment had better disease-free survival than those underwent upfront surgery by real-world statistic methods.