Ly Bevan Hong, Vlastos Georges, Rapiti Elisabetta, Vinh-Hung Vincent, Nguyen Nam Phong
John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
Tumori. 2010 Nov-Dec;96(6):947-54.
There is growing evidence of a survival benefit for metastatic breast cancer patients receiving surgery of the primary tumor. We investigated whether or not adjuvant radiotherapy can improve survival.
Women diagnosed between 1988 and 2003 with metastatic, histologically confirmed unilateral primary breast cancer were selected from the SEER Program. Overall survival and specific survival were computed by the Kaplan-Meier method. Treatment hazard ratios of breast-conserving surgery or mastectomy versus no surgery, and radiotherapy versus none, were computed by Cox regression adjusting for period of diagnosis, age, marital status, race, histology, grade, and hormone receptors.
Of 8761 women, radiotherapy was given to 1473 of 3905 who did not undergo surgery, to 882 of 2070 who underwent breast-conserving surgery, and to 1103 of 2786 mastectomy patients. Median overall survival was: for no surgery, 14 months; for breast-conserving surgery, 23 months; and for mastectomy, 28 months (P < 0.0001). The median overall survival of radiotherapy versus none was respectively 16 vs. 13 months without surgery (P = 0.0003), 28 vs. 20 months for breast-conserving surgery patients (P < 0.0001), and 28 vs. 28 months among mastectomy patients (P = 0.895). Multivariate analysis showed relative mortality reductions of 28% by breast-conserving surgery, 42% by mastectomy, and 10% by radiotherapy. Specific survival showed comparable results.
Surgery and radiotherapy were associated with a significant survival advantage. We argue that local therapy should be considered even in metastatic disease.
越来越多的证据表明，转移性乳腺癌患者接受原发肿瘤手术可带来生存获益。我们研究了辅助放疗是否能提高生存率。
从监测、流行病学与最终结果（SEER）计划中选取1988年至2003年间诊断为转移性、经组织学证实的单侧原发性乳腺癌的女性患者。采用Kaplan-Meier方法计算总生存率和特定生存率。通过Cox回归计算保乳手术或乳房切除术与未手术、放疗与未放疗相比的治疗风险比，并对诊断时间、年龄、婚姻状况、种族、组织学、分级和激素受体进行校正。
8761名女性中，3905名未接受手术的患者中有1473名接受了放疗，2070名接受保乳手术的患者中有882名接受了放疗，2786名乳房切除术患者中有1103名接受了放疗。中位总生存期为：未手术患者为14个月；保乳手术患者为23个月；乳房切除术患者为28个月（P<0.0001）。放疗与未放疗的中位总生存期在未手术患者中分别为16个月和13个月（P = 0.0003），保乳手术患者中分别为28个月和20个月（P<0.0001），乳房切除术患者中均为28个月（P = 0.895）。多变量分析显示，保乳手术使相对死亡率降低28%，乳房切除术降低42%，放疗降低10%。特定生存率显示出类似结果。
手术和放疗具有显著的生存优势。我们认为，即使是转移性疾病，也应考虑局部治疗。
