HER2 阳性乳腺癌传统上采用新辅助全身治疗 (NST) 进行治疗，但对于小肿瘤患者的最佳治疗顺序尚不清楚。我们调查了早期 HER2 阳性乳腺癌的临床病理学和肿瘤学结果。查询了一个机构数据库，以确定 2015 年至 2020 年接受治疗的 cT1-2 (≤ 3 cm) N0M0、HER2 阳性乳腺癌患者，并比较了前期手术和 NST队列。进行逻辑回归以确定预测升级的因素。使用时序检验比较各组的生存结果。在确定的 256 名患者中，170 名 (66.4%) 接受了前期手术，86 名 (33.6%) 接受了 NST。 NST 队列更年轻，有更多的 cT2 和 3 级肿瘤以及阴性前哨淋巴结。乳房手术类型或接受腋窝淋巴结切除术没有显着差异。前期手术后，4 名患者 (2.4%) 升级至 pT > 3 cm，18 名患者 (10.6%) 升级至 pN1-3。没有任何因素预示着会抢风头。 NST 后，47 例 (54.7%) 达到病理完全缓解，3 例 (3.5%) 因年龄较大（OR 1.08，p = 0.004）和激素受体阳性状态（OR 7.07，p = 0.002）而升期至 ypN1-3作为预测因子。中位随访时间为 3.55 年，10 名患者（3.9%）复发，5 名患者（2.0%）死亡。各组之间的肿瘤学结果没有显着差异。选择进行 NST 的 cT1-2 (≤ 3 cm)N0 HER2 阳性乳腺癌患者具有较高的疾病风险。观察到两组的病理升期率较低，手术治疗无差异，总体肿瘤学结果良好。这些发现可能会指导有关早期 HER2 阳性疾病患者的治疗顺序的决策。© 2024。外科肿瘤学会。

HER2-positive breast cancer is traditionally treated with neoadjuvant systemic therapy (NST), but optimal treatment sequencing is less clear in patients with small tumors. We investigated clinicopathologic and oncologic outcomes in early stage HER2-positive breast cancer.An institutional database was queried to identify patients with cT1-2 (≤ 3 cm) N0M0, HER2-positive breast cancer treated from 2015 to 2020 and compared upfront surgery and NST cohorts. Logistic regression was performed to identify factors predicting upstaging. Survival outcomes by group were compared using log-rank tests.Of 256 patients identified, 170 (66.4%) received upfront surgery and 86 (33.6%) NST. The NST cohort was younger and had more cT2 and grade 3 tumors and negative sentinel nodes. There was no significant difference in type of breast surgery or receipt of axillary lymphadenectomy. After upfront surgery, 4 (2.4%) patients had upstaging to pT > 3 cm and 18 (10.6%) to pN1-3. No factors predicted upstaging. After NST, 47 (54.7%) achieved pathologic complete response and 3 (3.5%) had upstaging to ypN1-3 with older age (OR 1.08, p = 0.004) and hormone receptor-positive status (OR 7.07, p = 0.002) identified as predictors. At median follow-up of 3.55 years, 10 (3.9%) patients had recurrence and 5 (2.0%) patients died. There were no significant differences in oncologic outcomes between groups.Patients with cT1-2 (≤ 3 cm)N0 HER2-positive breast cancer selected for NST have higher-risk disease. Low rates of pathologic upstaging were observed with no difference in surgical treatments and overall excellent oncologic outcomes in both groups. These findings may guide decision-making regarding treatment sequencing for patients with early stage HER2-positive disease.© 2024. Society of Surgical Oncology.