Francis Samual R, Frandsen Jonathan, Kokeny Kristine E, Gaffney David K, Poppe Matthew M
University of Utah Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT, USA.
University of Utah Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT, USA.
Breast. 2017 Apr;32:156-161. doi: 10.1016/j.breast.2017.02.001. Epub 2017 Feb 10.
The role of postmastectomy radiotherapy (PMRT) for women with pT3N0M0 breast cancer is controversial. We sought to determine the benefit of PMRT in this cohort using the National Cancer Database (NCDB).
We analyzed women with pT3N0M0 breast cancer who received mastectomy with or without PMRT between 2004 and 2012. We excluded men, women ≤18 years, neoadjuvant or unknown radiation or chemotherapy status, unknown estrogen or progesterone receptor status, unknown surgical margin status, histology other than invasive ductal or lobular carcinoma, and if death occurred <3 months after diagnosis. A total of 4291 patients was included for analysis. Chi-squared analysis was used to compare patient characteristics. Univariate (UVA) and multivariate (MVA) Cox proportional hazards modeling was used to identify factors associated with survival. Propensity score matching was performed to address confounding variables. Survival analysis was performed using Kaplan-Meier and shared frailty models.
Of the 4291 women analyzed, 2030 (47%) received PMRT. On MVA, PMRT (HR 0.72, p < 0.001), chemotherapy (HR 0.51, p < 0.001), and hormone therapy (HR 0.63, p < 0.001) were associated with improved overall survival (OS). After propensity score matching, a matched cohort of 2800 women was analyzed. At 5 years, OS was 83.7% and 79.8% with and without PMRT, respectively (p < 0.001). This difference in OS benefit increased with time. At 10 years, OS was 67.4% and 59.2% with and without PMRT, respectively.
PMRT was associated with improved OS in women with pT3N0M0 breast cancer, which strongly suggests PMRT may provide a survival advantage and should be considered.
对于pT3N0M0期乳腺癌女性患者，乳房切除术后放疗（PMRT）的作用存在争议。我们试图利用国家癌症数据库（NCDB）来确定PMRT在这一队列中的益处。
我们分析了2004年至2012年间接受乳房切除术且无论是否接受PMRT的pT3N0M0期乳腺癌女性患者。我们排除了男性、年龄≤18岁的女性、新辅助治疗或放疗或化疗状态未知者、雌激素或孕激素受体状态未知者、手术切缘状态未知者、浸润性导管癌或小叶癌以外的组织学类型，以及诊断后<3个月死亡的患者。共有4291例患者纳入分析。采用卡方分析比较患者特征。使用单因素（UVA）和多因素（MVA）Cox比例风险模型来确定与生存相关的因素。进行倾向评分匹配以处理混杂变量。使用Kaplan-Meier法和共享脆弱模型进行生存分析。
在分析的4291例女性患者中，2030例（47%）接受了PMRT。在多因素分析中，PMRT（风险比[HR]0.72，p<0.001）、化疗（HR 0.51，p<0.001）和激素治疗（HR 0.63，p<0.001）与总生存期（OS）改善相关。倾向评分匹配后，分析了一个匹配队列的2800例女性患者。5年时，接受和未接受PMRT的患者OS分别为83.7%和79.8%（p<0.001）。OS获益的这种差异随时间增加。10年时，接受和未接受PMRT的患者OS分别为67.4%和59.2%。
PMRT与pT3N0M0期乳腺癌女性患者的OS改善相关，这强烈提示PMRT可能提供生存优势，应予以考虑。
