Wang Xiaofang, Ma Jinli, Mei Xin, Yang Zhaozhi, Yu Xiaoli, Guo Xiaomao, Zhang Zhen, Shao Zhimin
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Oncol. 2018 Sep 12;2018:4736263. doi: 10.1155/2018/4736263. eCollection 2018.
This study examines factors associated with outcomes following salvage radiation and systemic therapy for breast cancer patients who developed isolated locoregional recurrence (ILRR) after mastectomy alone, while focusing on the prognostic significance of constructed biologic subtype in this setting.
269 postmastectomy patients in total treated for ILRR were included. Cumulative incidence of locoregional control (LRC), distant metastasis (DM)-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were calculated using Kaplan-Meier method. For statistical analysis, biologic subtypes were constructed from hormonal receptors (Rec) and HER2, consisting of Rec+/HER2-, Rec+/HER2+, Rec-/HER2+, and Rec-/HER2-. The association of clinic-pathological and treatment-related parameters with outcomes was evaluated using a Cox regression model.
At a median follow-up of 65 months, 56 (20.8%) patients failed to secure LRC after radiotherapy, and 165 patients (61.3%) developed DM. Overall, the actuarial 5-year LRC, DMFS, DFS, and OS rate was 77.3%, 45.6%, 43.9%, and 66.8%, respectively. Multivariate analysis revealed that constructed biologic subtype represented the most significant prognostic factor for any outcome. Compared to patients with Rec+/HER2- disease, those with Rec-/HER2- had significantly poorer 5-year LRC (84.2% versus 58.3%, HR = 4.36, P < 0.001) and worse survivals including 5-year DMFS (63.0% versus 15.8%, HR = 4.28, P < 0.001), DFS (59.7% versus 13.6%, HR=3.92, P < 0.001), and OS (87.8% versus 22.3%, HR = 8.55, P < 0.001). Other factors associated with reduced LRC were no radical surgery and involved field irradiation alone, whereas factors associated with poor survivals included positive nodes at primary diagnosis and regional recurrence.
Constructed biologic subtypes remained to be predictive of both disease control and survivals after salvage radiation for postmastectomy ILRR. Notably, Rec-/HER2- patients were demonstrated to be at high risk of locoregional failure and subsequent DM and tended to have worse survivals despite salvage therapies.
本研究探讨单纯乳房切除术后发生孤立性局部区域复发（ILRR）的乳腺癌患者接受挽救性放疗和全身治疗后与预后相关的因素，同时关注在此情况下构建的生物学亚型的预后意义。
共纳入269例接受ILRR治疗的乳房切除术后患者。采用Kaplan-Meier法计算局部区域控制（LRC）、无远处转移（DM）生存（DMFS）、无病生存（DFS）和总生存（OS）的累积发生率。为进行统计分析，根据激素受体（Rec）和HER2构建生物学亚型，包括Rec+/HER2-、Rec+/HER2+、Rec-/HER2+和Rec-/HER2-。使用Cox回归模型评估临床病理和治疗相关参数与预后的关联。
中位随访65个月时，56例（20.8%）患者放疗后未获得LRC，165例（61.3%）患者发生DM。总体而言，5年LRC、DMFS、DFS和OS的精算率分别为77.3%、45.6%、43.9%和66.8%。多因素分析显示，构建的生物学亚型是任何预后的最显著预后因素。与Rec+/HER2-疾病患者相比，Rec-/HER2-患者的5年LRC显著更差（84.2%对58.3%，HR = 4.36，P < 0.001），包括5年DMFS（63.0%对15.8%，HR = 4.28，P < 0.001）、DFS（59.7%对13.6%，HR = 3.92，P < 0.001）和OS（87.8%对22.3%，HR = 8.55，P < 0.001）在内的生存率也更差。与LRC降低相关的其他因素是未进行根治性手术和仅进行累及野照射，而与生存率差相关的因素包括初次诊断时淋巴结阳性和区域复发。
构建的生物学亚型仍然可以预测乳房切除术后ILRR患者挽救性放疗后的疾病控制和生存情况。值得注意的是，Rec-/HER2-患者被证明有局部区域失败和随后发生DM的高风险，并且尽管接受了挽救性治疗，其生存率往往更差。
