Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Cancer Res Treat. 2019 Jul;51(3):1041-1051. doi: 10.4143/crt.2018.424. Epub 2018 Nov 1.
We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy.
We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups.
The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly.
There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.
我们比较了在蒽环类和紫杉类药物（AT）方案下保乳手术加放疗（BCS+RT）和改良根治性乳房切除术（MRM）的肿瘤学结果，并研究了辅助放疗（RT）在接受乳房切除术的病理 N1（pN1）乳腺癌患者中的作用。
我们回顾性分析了 2006 年 1 月至 2010 年 12 月 12 家机构的 2011 例 pN1 乳腺癌患者的病历，这些患者接受了 BCS+RT 或单独 MRM 治疗。采用 2:1 倾向评分匹配来平衡组间变量。
全队列的中位随访时间为 69 个月（范围 1 至 114 个月）。在进行倾向评分匹配后，最终分析了 1074 例患者（BCS+RT 组 676 例，MRM 组 398 例）。BCS+RT 组与 MRM 组的总生存、无病生存、局部区域无失败生存和区域无失败生存（RFFS）曲线无显著差异。亚组分析显示，在同时存在淋巴管血管侵犯（LVI）和组织学分级（HG）III 的患者中，BCS+RT 显著提高了 RFFS（p=0.008）。BCS+RT 组的淋巴水肿（p=0.007）和放射性肺炎（p=0.031）发生率显著高于 MRM 组。
在 AT 化疗方案下，pN1 乳腺癌患者接受 BCS+RT 和单独 MRM 治疗的肿瘤学结果无差异。然而，在 LVI 和 HG III 的患者中，BCS+RT 组的 RFFS 优于 MRM 组。对于 LVI 和 HG III 的 pN1 乳腺癌患者，辅助 RT 可能是值得考虑的。
