Paul Wright G, Drinane James J, Sobel Holly L, Chung Mathew H
Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA.
Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
Ann Surg Oncol. 2016 Apr;23(4):1117-22. doi: 10.1245/s10434-015-4949-6. Epub 2015 Nov 3.
Standard therapy following lumpectomy for breast cancer has included adjuvant whole-breast radiotherapy. Recent, long-term studies have suggested a possible association between left-sided whole breast radiotherapy and long-term cardiac-related mortality. We sought to determine whether left-sided breast cancers treated with breast-conserving treatment have worse cardiac-related outcomes.
The surveillance, epidemiology, and end results database was queried for female breast cancer cases diagnosed from 1990 to 1999. Subjects who underwent lumpectomy and adjuvant radiotherapy were included for study and grouped according to laterality. The primary outcome measure was the rate of cardiac-related mortality. Secondary outcome measures were overall and cancer-specific survival. A Cox proportional hazards model was constructed to analyze the primary outcome measure and included age, race, grade, stage, hormone receptor status, and histologic subtype.
A total of 66,687 subjects were identified. These were divided equally by laterality groups: 33,866 left (50.8 %) and 32,801 right (49.2 %). Median follow-up was 15.5 years, and the groups were otherwise well-matched. Left-sided cancer was not associated with poorer survival for any of the metrics. Fifteen-year overall survival and disease-specific survival were 62.8 and 87.0 % for left-sided and 63.0 and 87.1 % for right-sided breast cancers, respectively (p = 0.260, p = 0.702). Rate of cardiac-related mortality at 5-, 10-, and 15-year follow-up were 1.5, 4.3, and 7.7 % for left-sided cancers and 1.6, 4.4, and 8.0 % for right-sided cancers, respectively (p = 0.435).
In this large population-based study, women receiving left-sided external beam radiation for breast cancer did not have an increase in cardiac-related mortality.
乳腺癌保乳术后的标准治疗包括辅助性全乳放疗。近期的长期研究表明，左侧全乳放疗与长期心脏相关死亡率之间可能存在关联。我们试图确定接受保乳治疗的左侧乳腺癌患者是否有更差的心脏相关结局。
查询监测、流行病学和最终结果数据库中1990年至1999年诊断的女性乳腺癌病例。纳入接受保乳手术和辅助放疗的受试者进行研究，并根据病变侧别分组。主要结局指标是心脏相关死亡率。次要结局指标是总生存率和癌症特异性生存率。构建Cox比例风险模型分析主要结局指标，并纳入年龄、种族、分级、分期、激素受体状态和组织学亚型。
共识别出66687名受试者。这些受试者按病变侧别组平均分配：左侧33866名（50.8%），右侧32801名（49.2%）。中位随访时间为15.5年，且两组在其他方面匹配良好。左侧癌症在任何指标上均与较差的生存率无关。左侧乳腺癌的15年总生存率和疾病特异性生存率分别为62.8%和87.0%，右侧乳腺癌分别为63.0%和87.1%（p = 0.260，p = 0.702）。左侧癌症在5年、10年和15年随访时的心脏相关死亡率分别为1.5%、4.3%和7.7%，右侧癌症分别为1.6%、4.4%和8.0%（p = 0.435）。
在这项基于人群的大型研究中，接受左侧乳腺癌外照射的女性心脏相关死亡率没有增加。
