Abrams Matthew J, Koffer Paul P, Wazer David E, Hepel Jaroslaw T
Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts.
Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):384-391. doi: 10.1016/j.ijrobp.2017.02.007. Epub 2017 Feb 13.
Because of its rarity, there are no randomized trials investigating postmastectomy radiation therapy (PMRT) in male breast cancer. This study retrospectively examines the impact of PMRT in male breast cancer patients in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.
The SEER database 8.3.2 was queried for men ages 20+ with a diagnosis of localized or regional nonmetastatic invasive ductal/lobular carcinoma from 1998 to 2013. Included patients were treated by modified radical mastectomy (MRM), with or without adjuvant external beam radiation. Univariate and multivariate analyses evaluated predictors for PMRT use after MRM. Kaplan-Meier overall survival (OS) curves of the entire cohort and a case-matched cohort were calculated and compared by the log-rank test. Cox regression was used for multivariate survival analyses.
A total of 1933 patients were included in the unmatched cohort. There was no difference in 5-year OS between those who received PMRT and those who did not (78% vs 77%, respectively, P=.371); however, in the case-matched analysis, PMRT was associated with improved OS at 5 years (83% vs 54%, P<.001). On subset analysis of the unmatched cohort, PMRT was associated with improved OS in men with 1 to 3 positive nodes (5-year OS 79% vs 72% P=.05) and those with 4+ positive nodes (5-year OS 73% vs 53% P<.001). On multivariate analysis of the unmatched cohort, independent predictors for improved OS were use of PMRT: HR=0.551 (0.412-0.737) and estrogen receptor-positive disease: HR=0.577 (0.339-0.983). Predictors for a survival detriment were higher grade 3/4: HR=1.825 (1.105-3.015), larger tumor T2: HR=1.783 (1.357-2.342), T3/T4: HR=2.683 (1.809-3.978), higher N-stage: N1 HR=1.574 (1.184-2.091), N2/N3: HR=2.328 (1.684-3.218), black race: HR=1.689 (1.222-2.336), and older age 81+: HR=4.164 (1.497-11.582).
There may be a survival benefit with the addition of PMRT for male breast cancer with node-positive disease.
由于男性乳腺癌罕见，尚无关于男性乳腺癌乳房切除术后放疗（PMRT）的随机试验。本研究回顾性分析国家癌症研究所监测、流行病学和最终结果（SEER）数据库中男性乳腺癌患者接受PMRT的影响。
查询SEER数据库8.3.2，纳入1998年至2013年年龄≥20岁、诊断为局限性或区域性非转移性浸润性导管/小叶癌的男性患者。纳入患者均接受改良根治性乳房切除术（MRM），术后接受或未接受辅助外照射放疗。单因素和多因素分析评估MRM后PMRT使用的预测因素。计算整个队列及病例匹配队列的Kaplan-Meier总生存（OS）曲线，并通过对数秩检验进行比较。采用Cox回归进行多因素生存分析。
未匹配队列共纳入1933例患者。接受PMRT和未接受PMRT患者的5年总生存率无差异（分别为78%和77%，P = 0.371）；然而，在病例匹配分析中，PMRT与5年总生存率提高相关（83%对54%，P < 0.001）。对未匹配队列进行亚组分析时，PMRT与1至3个阳性淋巴结男性患者的总生存率提高相关（5年总生存率79%对72%，P = 0.05）以及4个以上阳性淋巴结患者（5年总生存率73%对53%，P < 0.001）。对未匹配队列进行多因素分析时，总生存率提高的独立预测因素为使用PMRT：HR = 0.551（0.412 - 0.737）和雌激素受体阳性疾病：HR = 0.577（0.339 - 0.983）。生存受损的预测因素为更高的3/4级：HR = 1.825（1.105 - 3.015）、更大的肿瘤T2：HR = 1.783（1.357 - 2.342）、T3/T4：HR = 2.683（1.809 - 3.978）、更高N分期：N1 HR = 1.574（1.184 - 2.091）、N2/N3：HR = 2.328（1.684 - 3.218）、黑人种族：HR = 1.689（1.222 - 2.336）以及年龄≥81岁：HR = 4.164（1.497 - 11.582）。
对于淋巴结阳性的男性乳腺癌患者，增加PMRT可能有生存获益。
