Cassidy Richard J, Liu Yuan, Kahn Shannon T, Jegadeesh Naresh K, Liu Xi, Subhedar Preeti D, Arciero Cletus A, Gillespie Theresa W, Torres Mylin A
Department of Radiation Oncology, Emory University, Atlanta, Georgia.
Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Cancer. 2017 Aug 1;123(15):2829-2839. doi: 10.1002/cncr.30675. Epub 2017 Apr 7.
The authors determined the impact of postmastectomy radiotherapy (PMRT) on overall survival (OS) among patients with pT3N0M0 breast cancer in the National Cancer Data Base.
A total of 3437 patients with pT3N0M0 breast cancer who initially were treated with mastectomy between 2003 and 2011 were identified. Of these women, 1644 (47.8%) received PMRT (67% treated with chest wall RT alone and 33% treated with chest wall and regional lymph node irradiation). Univariable and multivariable analyses were conducted to identify characteristics associated with PMRT and OS. In addition, propensity score matching and interaction effect testing also were performed.
PMRT was associated with age <40 years, private insurance coverage, treatment facility location within 10 miles of the patient's home zip code, Charlson-Deyo comorbidity score of 0, tumor size ≥7 cm, and treatment with chemotherapy or hormone therapy (all P<.05). PMRT was associated with improved 5-year OS (86.3% for patients treated with PMRT vs 66.4% for patients not treated with PMRT; P<.01). In addition to PMRT (hazard ratio, 0.72; 95% confidence interval, 0.59-0.87 [P<.01]), age ≤50 years, treatment at an academic/research program, Charlson-Deyo comorbidity score of 0, tumor size <7 cm, chemotherapy receipt, and hormone therapy receipt were associated with improved OS on multivariable analyses (all P<.05). Interaction testing found that PMRT improved OS independent of age, facility type, Charlson-Deyo comorbidity score, tumor grade and size, surgical margin status, and receipt of chemotherapy or hormone therapy (all P>.1). Finally, propensity score matching analysis confirmed the impact of PMRT on OS (P = .02). It is interesting to note that regional lymph node irradiation did not improve OS versus chest wall RT alone (P = .09).
Among patients with pT3N0M0 breast cancer in the National Cancer Data Base, PMRT was found to be associated with improved OS regardless of surgical margin status, tumor size, and receipt of systemic therapy. Cancer 2017;123:2829-39. © 2017 American Cancer Society.
作者在国家癌症数据库中确定了乳房切除术后放疗（PMRT）对pT3N0M0乳腺癌患者总生存期（OS）的影响。
共纳入2003年至2011年间最初接受乳房切除术的3437例pT3N0M0乳腺癌患者。其中，1644例（47.8%）接受了PMRT（67%仅接受胸壁放疗，33%接受胸壁和区域淋巴结照射）。进行单变量和多变量分析以确定与PMRT和OS相关的特征。此外，还进行了倾向评分匹配和交互作用测试。
PMRT与年龄<40岁、私人保险覆盖、治疗机构位于患者家庭邮政编码10英里范围内、Charlson-Deyo合并症评分为0、肿瘤大小≥7 cm以及接受化疗或激素治疗相关（所有P<.05）。PMRT与5年OS改善相关（接受PMRT治疗的患者为86.3%，未接受PMRT治疗的患者为66.4%；P<.01）。除PMRT外（风险比，0.72；95%置信区间，0.59 - 0.87 [P<.01]），年龄≤50岁、在学术/研究项目中接受治疗、Charlson-Deyo合并症评分为0、肿瘤大小<7 cm、接受化疗和接受激素治疗在多变量分析中与OS改善相关（所有P<.05）。交互作用测试发现，PMRT独立于年龄、机构类型、Charlson-Deyo合并症评分、肿瘤分级和大小、手术切缘状态以及接受化疗或激素治疗改善OS（所有P>.1）。最后，倾向评分匹配分析证实了PMRT对OS的影响（P =.02）。有趣的是，区域淋巴结照射与仅胸壁放疗相比并未改善OS（P =.09）。
在国家癌症数据库中，pT3N0M0乳腺癌患者中，发现PMRT与OS改善相关，无论手术切缘状态、肿瘤大小和全身治疗情况如何。《癌症》2017年；123：2829 - 39。©2017美国癌症协会。
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