Corradini Stefanie, Niyazi Maximilian, Niemoeller Olivier M, Li Minglun, Roeder Falk, Eckel Renate, Schubert-Fritschle Gabriele, Scheithauer Heike R, Harbeck Nadia, Engel Jutta, Belka Claus
Department of Radiation Oncology, University of Munich, Germany.
Department of Radiation Oncology, University of Munich, Germany.
Radiother Oncol. 2015 Jan;114(1):28-34. doi: 10.1016/j.radonc.2014.08.027. Epub 2014 Sep 15.
The purpose of this retrospective outcome study was to validate the effectiveness of postoperative radiotherapy in breast conserving therapy (BCT) and to evaluate possible causes for omission of radiotherapy after breast conserving surgery (BCS) in a non-trial population.
Data were provided by the population-based Munich Cancer Registry. The study included epidemiological data of 30.811 patients diagnosed with breast cancer from 1998 to 2012. The effect of omitting radiotherapy was analysed using Kaplan-Meier-estimates and Cox proportional hazard regression. Variables predicting omission of radiotherapy were analysed using multivariate logistic regression.
Use of postoperative radiotherapy after BCS was associated with significant improvements in local control and survival. 10-year loco-regional recurrence-free-survival was 90.8% with postoperative radiotherapy vs. 77.6% with surgery alone (p<0.001). 10-year overall survival rates were 55.2% with surgery alone vs. 82.2% following postoperative radiotherapy (p<0.001). Variables predicting omission of postoperative radiotherapy included advanced age (women ⩾80 years; OR: 0.082; 95% CI: 0.071-0.094, p<0.001).
This study shows a decrease in local control and a survival disadvantage if postoperative radiotherapy after breast conserving surgery is omitted in an unselected cohort of primary breast cancer patients. Due to its epidemiological nature, it cannot answer the question in whom postoperative radiotherapy can be safely omitted.
这项回顾性结果研究旨在验证保乳治疗（BCT）中术后放疗的有效性，并评估非试验人群中保乳手术（BCS）后未进行放疗的可能原因。
数据由基于人群的慕尼黑癌症登记处提供。该研究纳入了1998年至2012年诊断为乳腺癌的30811名患者的流行病学数据。使用Kaplan-Meier估计法和Cox比例风险回归分析未进行放疗的影响。使用多因素逻辑回归分析预测未进行放疗的变量。
保乳手术后使用术后放疗与局部控制和生存率的显著改善相关。术后放疗组的10年局部区域无复发生存率为90.8%，单纯手术组为77.6%（p<0.001）。单纯手术组的10年总生存率为55.2%，术后放疗组为82.2%（p<0.001）。预测未进行术后放疗的变量包括高龄（年龄≥80岁的女性；OR：0.082；95%CI：0.071-0.094，p<0.001）。
本研究表明，在未经选择的原发性乳腺癌患者队列中，如果保乳手术后省略术后放疗，局部控制会降低且存在生存劣势。由于其流行病学性质，它无法回答哪些患者可以安全地省略术后放疗的问题。
