Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.
Cancer Med. 2019 Feb;8(2):554-563. doi: 10.1002/cam4.1954. Epub 2019 Jan 10.
OBJECTIVES: The value of adjuvant radiotherapy for triple-negative breast cancer (TNBC) has been controversial recently. This study aims to clarify the influence of radiotherapy on the survival of TNBC patients after surgery based on a large population analysis. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was exploited to select eligible patients from 2010 to 2014. The categorical variables were examined by chi-square tests. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared among patients who received or not received adjuvant radiotherapy after surgery by Kaplan-Meier method with log-rank test. Univariate and multivariate survival analysis of BCSS and OS were performed using the Cox proportional hazard model. RESULTS: Totally 22 802 patients were enrolled in this study, of which 10 905 patients received radiotherapy after surgery while 11 897 patients did not receive radiotherapy. Compared with those patients who did not receive radiotherapy, the radiation group had a larger proportion of tumor size <2.0 cm (45.8% vs 38.8%) and chemotherapy (82.5% vs 67.4%). The Kaplan-Meier plots displayed that patients in the radiation group had better survival than the no radiation group in both BCSS and OS (P < 0.001, respectively). In univariate Cox analysis of BCSS, age 40-60, married status, white and other race, chemotherapy, radiation, and surgery were associated with better survival (HR < 1, P < 0.05). Specifically, patients who received radiotherapy exhibited better BCSS (HR = 0.52, 95% CI = 0.48-0.57, P < 0.001). After adjusting for confounding factors by multivariable Cox regression analysis, receipt of radiotherapy was still associated with improved BCSS (HR = 0.79, 95% CI = 0.72-0.87, P < 0.001). Survival analysis of OS produced similar results. Generally, these data indicate that radiotherapy after surgery has significant survival benefits for the TNBC patients. CONCLUSIONS: This study has confirmed the survival advantage of adjuvant radiotherapy for the TNBC patients. These findings may optimize the current individualized treatment decisions for this patient population.
目的：最近，辅助放疗对三阴性乳腺癌（TNBC）的价值存在争议。本研究旨在基于大人群分析，阐明放疗对 TNBC 患者手术后生存的影响。
方法：利用监测、流行病学和最终结果（SEER）数据库，从 2010 年至 2014 年选择符合条件的患者。采用卡方检验对分类变量进行检验。通过 Kaplan-Meier 法和对数秩检验比较手术后接受或未接受辅助放疗的患者的乳腺癌特异性生存（BCSS）和总生存（OS）。采用 Cox 比例风险模型对 BCSS 和 OS 进行单因素和多因素生存分析。
结果：本研究共纳入 22802 例患者，其中 10905 例患者手术后接受放疗，11897 例患者未接受放疗。与未接受放疗的患者相比，放疗组肿瘤大小<2.0cm（45.8%比 38.8%）和化疗（82.5%比 67.4%）的比例较大。Kaplan-Meier 图显示，在 BCSS 和 OS 方面，放疗组患者的生存均优于无放疗组（P均<0.001）。BCSS 的单因素 Cox 分析中，年龄 40-60 岁、已婚、白人及其他种族、化疗、放疗和手术与生存改善相关（HR<1，P<0.05）。具体而言，接受放疗的患者具有更好的 BCSS（HR=0.52，95%CI=0.48-0.57，P<0.001）。多因素 Cox 回归分析调整混杂因素后，放疗仍与改善的 BCSS 相关（HR=0.79，95%CI=0.72-0.87，P<0.001）。OS 的生存分析得出了类似的结果。总体而言，这些数据表明，手术后放疗对 TNBC 患者具有显著的生存获益。
结论：本研究证实了辅助放疗对 TNBC 患者的生存优势。这些发现可能优化当前针对该患者群体的个体化治疗决策。
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