Mamtani Anita, Patil Sujata, Stempel Michelle M, Morrow Monica
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 2017 Jul 15;123(14):2626-2633. doi: 10.1002/cncr.30658. Epub 2017 Mar 23.
Indications for postmastectomy radiotherapy (PMRT) in patients with T1 to T2, lymph node-negative (N0) breast cancer with "high-risk" features are controversial. The European Organization for Research and Treatment of Cancer (EORTC) 22922 and National Cancer Institute of Canada Clinical Trials Group MA20 trials reporting improved 10-year disease-free survival with lymph node irradiation included patients with high-risk N0 disease, but, to the authors' knowledge, benefits in patients receiving modern systemic therapy are uncertain.
The authors retrospectively identified patients with T1 to T2N0 disease who were treated with mastectomy from January 2006 through December 2011. High-risk features included age <40 years, multifocality/multicentricity, lymphovascular invasion, medial/central tumor location, and high nuclear grade.
Among 672 eligible patients, only 15 received PMRT and were excluded. Of the remaining 657 patients, 187 (28%) had 1 high-risk feature and 449 patients (68%) had ≥ 2 high-risk features. A total of 36 patients with unknown tumor grade were excluded from risk analysis. Approximately 98% of patients underwent sentinel lymph node biopsy alone and 86% received adjuvant systemic therapy. At a median of 5.6 years of follow-up, the locoregional disease recurrence (LRR) rate was 4.7% (31 patients). Increasing tumor size was found to be associated with LRR (hazard ratio, 1.70; P = .006), whereas other high-risk features were not (all P > .05). Receipt of systemic therapy decreased the LRR rate (hazard ratio, 0.40; P = .03). Although crude LRR rates increased from 3.8% to 9.4% with 1 versus ≥ 4 high-risk features, the number of risk factors was not found to be significantly associated with LRR (P = .54).
In the current study, a low crude LRR rate (4.7%) was observed in a large unselected cohort of patients with T1 to T2N0 breast cancer with high-risk features who were treated with mastectomy and systemic therapy without PMRT. Although increasing tumor size and the omission of systemic therapy were found to be predictive, other features did not confer a higher LRR risk either independently or together, and do not by themselves mandate the use of PMRT in this patient population. Cancer 2017;123:2626-33. © 2017 American Cancer Society.
对于具有“高危”特征的T1至T2期、淋巴结阴性（N0）乳腺癌患者，乳房切除术后放疗（PMRT）的指征存在争议。欧洲癌症研究与治疗组织（EORTC）22922试验和加拿大国家癌症研究所临床试验组MA20试验报告称，淋巴结照射可提高10年无病生存率，其中包括高危N0疾病患者，但据作者所知，接受现代全身治疗的患者的获益尚不确定。
作者回顾性确定了2006年1月至2011年12月期间接受乳房切除术治疗的T1至T2N0疾病患者。高危特征包括年龄<40岁、多灶性/多中心性、淋巴管浸润、肿瘤位于内侧/中央以及高核分级。
在672例符合条件的患者中，仅15例接受了PMRT并被排除。在其余657例患者中，187例（28%）有1项高危特征，449例（68%）有≥2项高危特征。共有36例肿瘤分级未知的患者被排除在风险分析之外。约98%的患者仅接受了前哨淋巴结活检，86%的患者接受了辅助全身治疗。在中位随访5.6年时，局部区域疾病复发（LRR）率为4.7%（31例患者）。发现肿瘤大小增加与LRR相关（风险比，1.70；P = 0.006），而其他高危特征则无此相关性（所有P>0.05）。接受全身治疗可降低LRR率（风险比，0.40；P = 0.03）。尽管1项高危特征与≥4项高危特征的粗LRR率分别为3.8%和9.4%，但未发现风险因素数量与LRR有显著相关性（P = 0.54）。
在本研究中，在一大组未经过筛选的具有高危特征的T1至T2N0乳腺癌患者中，观察到较低的粗LRR率（4.7%），这些患者接受了乳房切除术和全身治疗，未接受PMRT。尽管发现肿瘤大小增加和未接受全身治疗具有预测性，但其他特征单独或共同均未赋予更高的LRR风险，其本身并不要求对该患者群体使用PMRT。《癌症》2017年；123：2626 - 33。©2017美国癌症协会
