目的：分析曲妥珠单抗辅助治疗的HER2阳性乳腺癌病人的预后影响因素。方法：对2009年1月至2019年12月间1 246例初诊HER2阳性乳腺癌接受曲妥珠单抗治疗病人的临床资料进行回顾性分析，用Log-rank单因素分析及多因素COX回归分析研究其预后的影响因素。结果：接受曲妥珠单抗治疗的HER2阳性病人pT_2~3期（HR=2.10，P=0.003）、pN_2~3期（HR=2.81，P<0.001）、未行内分泌治疗（HR=2.50，P<0.001）者预后较差，用紫杉类或其他化疗方案（HR=0.40，P=0.017）的预后较好。根据淋巴结转移情况将病人分成两个亚组。发现淋巴结未转移者pT_2~3期组（P=0.020）预后较差，紫杉类或其他化疗组（P=0.032）预后较好；淋巴结转移者pT_2~3期组（P=0.012）、未行内分泌治疗组（P=0.001）预后较差。结论：接受曲妥珠单抗治疗的HER2阳性乳腺癌病人可分类管理治疗：无淋巴结转移的小肿瘤病人更推荐联合去蒽环类的化疗方案治疗以达到更好的预后；淋巴结转移、肿块较大的病人在化疗方案可选择的情况下，更推荐使用豁免蒽环类药物的方案，在保证达到相同预后的同时，减少化疗不良反应带来的危害。

Objective To analyze the prognostic factors in the patients with HER2-positive breast cancer adjuvant treated with trastuzumab. Methods We conducted a retrospective analysis of clinical data of 1 246 patients diagnosed with HER2-positive breast cancer between January 2009 and December 2019 who received treatment with trastuzumab. We investigated the factors impacting their prognosis by the Log-rank test univariate analysis and multivariate COX regression analysis. Results HER2-positive patients treated with trastuzumab had a poor prognosis in pT_2-3(HR=2.10, P=0.003), pN_2-3(HR=2.81, P<0.001), and no endocrine therapy (HR=2.50, P<0.001), and that had a better prognosis combined with taxane or other chemotherapy regimens (HR=0.40, P=0.017). We divided the patients into two subgroups according to the status of lymph node metastasis, and we found that in the negative lymph nodes group the patients with pT_2-3 stage had poor prognosis (P=0.020), while the patients combined with taxane or other chemotherapy had better prognosis (P=0.032). In the positive lymph nodes group the patients with pT_2-3 stage and no endocrine therapy had poor prognosis (P=0.012, P=0.001). Conclusions The patients with HER2-positive breast cancer treated with trastuzumab can be managed in different categories, for individuals without lymph node involvement and small tumor sizes, combining therapy with non-anthracycline chemotherapy is preferable for achieving improved outcomes, for patients with lymph node metastasis and large tumor sizes, if chemotherapy options are available, it is more recommended to use an anthracycline-free regimen to ensure the same prognosis while reducing the harm caused by the toxic side effects of chemotherapy.