Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
Strahlenther Onkol. 2019 Apr;195(4):297-305. doi: 10.1007/s00066-018-1343-x. Epub 2018 Aug 1.
To assess the impact of postmastectomy radiotherapy (PMRT) on overall survival and relapse-free survival among breast cancer patients with T1-T2 N1 disease who received standard adjuvant systemic therapy.
This is an individual patient data pooled analysis of 1053 breast cancer patients referred for adjuvant therapy in three clinical trials (BIG 02/98, BCIRG001, and BCIRG005). Overall survival was assessed according to whether or not patients received adjuvant radiotherapy through Kaplan-Meier analysis. Univariate and multivariate analyses of predictors of overall and relapse-free survival were conducted through Cox regression analysis.
Locoregional relapse rates (after a median follow up of 116 months) were 5.6% among patients who received adjuvant radiotherapy vs. 6.6% among patients who did not receive adjuvant radiotherapy. Actuarial 5‑ and 10-year locoregional relapse-free survival rates were 94 and 93%, respectively, among patients who did not receive adjuvant radiotherapy versus 95 and 92% among patients who received adjuvant radiotherapy. The following factors were associated with worse overall survival in multivariate Cox regression analysis: age < 40 years (P < 0.0001), T2 stage (P = 0.004), higher lymph node ratio (P < 0.0001), and negative hormone receptor status (P < 0.0001). Likewise, the following factors were predictive of shorter locoregional relapse-free survival: age ≤ 40 (P < 0.0001), no PMRT (P = 0.034), fluorouracil/adriamycin/cyclophosphamide (FAC) chemotherapy (P = 0.001), and higher T stage (P = 0.002).
The current analysis does not show a beneficial impact of PMRT on overall or relapse-free survival among patients with T1-T2 N1 disease who received standard adjuvant systemic therapy. There is, however, evidence of improvement in locoregional relapse-free survival with PMRT. These findings need to be prospectively validated.
评估标准辅助全身治疗后 T1-T2N1 期乳腺癌患者接受乳房切除术放疗（PMRT）对总生存和无复发生存的影响。
这是对三个临床试验（BIG02/98、BCIRG001 和 BCIRG005）中接受辅助治疗的 1053 例乳腺癌患者的个体患者数据汇总分析。通过 Kaplan-Meier 分析评估是否接受辅助放疗对总生存的影响。通过 Cox 回归分析进行总生存和无复发生存预测因素的单变量和多变量分析。
在中位随访 116 个月后，接受辅助放疗的患者局部区域复发率（LRR）为 5.6%，未接受辅助放疗的患者为 6.6%。未接受辅助放疗的患者 5 年和 10 年局部区域无复发生存率分别为 94%和 93%，而接受辅助放疗的患者分别为 95%和 92%。多变量 Cox 回归分析显示，以下因素与较差的总生存相关：年龄<40 岁（P<0.0001）、T2 期（P=0.004）、较高的淋巴结比率（P<0.0001）和阴性激素受体状态（P<0.0001）。同样，以下因素预测局部区域无复发生存较短：年龄≤40 岁（P<0.0001）、无 PMRT（P=0.034）、氟尿嘧啶/阿霉素/环磷酰胺（FAC）化疗（P=0.001）和较高的 T 期（P=0.002）。
目前的分析并未显示标准辅助全身治疗后 T1-T2N1 期乳腺癌患者接受 PMRT 对总生存或无复发生存有获益。然而，PMRT 可改善局部区域无复发生存。这些发现需要前瞻性验证。
