Chen Kai, Li Shunrong, Li Qian, Zhu Liling, Liu Yujie, Song Erwei, Su Fengxi
From the Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
Medicine (Baltimore). 2016 Feb;95(8):e2593. doi: 10.1097/MD.0000000000002593.
This study used the Surveillance, Epidemiology, and End Results database to compare breast-conserving surgery (BCS) rates across patients with different molecular subtypes.We identified female breast cancer patients who were diagnosed between 2010 and 2012 using the Surveillance, Epidemiology, and End Results database. Patients without available critical clinicopathological information were excluded. The chi-square test and logistic regression analysis were used to investigate factors associated with BCS.This study identified 85,415 T1-2N0-3M0 breast cancer patients. Among the patients with HR+/HER2-, HR+/HER2+, HR-/HER2+, and HR-/HER2- diseases, 63.5% (38,823/61,142), 51.2% (4850/9473), 43.2% (1740/4030), and 55.7% (6000/10,770), respectively, received BCS (P < 0.01). Patients with HR-/HER2+ (odds ratio 0.58; 95% confidence interval, 0.54-0.62) disease were significantly less likely to receive BCS than patients with HR+/HER2- disease after adjustment for T-stage, N-stage, age, tumor grade, county type, and race. Differences in BCS rates between the HR+/HER2- and HR-/HER2+ subgroups were 29.1%, 14.0%, 10.1%, 8.5%, and 0.2% in patients with tumor sizes <10 mm, 10 to 20 mm, 20 to 30 mm, 30 to 40 mm, and 40 to 50 mm, respectively. Differences in BCS rates between the HR+/HER2- and HR-/HER2+ subgroups were 20.3% and 5.7% in node-negative and node-positive patients, respectively. BCS rates in patients with grades I, II, and III tumors in the HR+/HER2- and HR-/HER2+ subgroups were 72.2% and 34.6%, 62.7% and 42.3%, and 54.7% and 43.4%, respectively.Our study demonstrated that BCS rates varied significantly across molecular subtypes, especially in patients with lower tumor burden. HR+/HER2- and HR-/HER2+ patients exhibited the highest and lowest BCS rates, respectively.
本研究使用监测、流行病学和最终结果数据库，比较不同分子亚型患者的保乳手术（BCS）率。我们通过监测、流行病学和最终结果数据库确定了2010年至2012年期间确诊的女性乳腺癌患者。排除没有可用关键临床病理信息的患者。采用卡方检验和逻辑回归分析来研究与BCS相关的因素。本研究确定了85415例T1-2N0-3M0乳腺癌患者。在HR+/HER2-、HR+/HER2+、HR-/HER2+和HR-/HER2-疾病患者中，分别有63.5%（38823/61142）、51.2%（4850/9473）、43.2%（1740/4030）和55.7%（6000/10770）接受了BCS（P<0.01）。在调整T分期、N分期、年龄、肿瘤分级、县类型和种族后，HR-/HER2+疾病患者接受BCS的可能性显著低于HR+/HER2-疾病患者（比值比0.58；95%置信区间，0.54-0.62）。肿瘤大小<10mm、10至20mm、20至30mm、30至40mm和40至50mm的患者中，HR+/HER2-和HR-/HER2+亚组之间的BCS率差异分别为29.1%、14.0%、10.1%、8.5%和0.2%。HR+/HER2-和HR-/HER2+亚组之间淋巴结阴性和阳性患者的BCS率差异分别为20.3%和5.7%。HR+/HER2-和HR-/HER2+亚组中I级、II级和III级肿瘤患者的BCS率分别为72.2%和34.6%、62.7%和42.3%、54.7%和43.4%。我们的研究表明，不同分子亚型的BCS率差异显著，尤其是肿瘤负荷较低的患者。HR+/HER2-和HR-/HER2+患者的BCS率分别最高和最低。
