Department of Breast Surgery, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Science; Cancer Hospital of the University of Chinese Academy of Sciences; Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang, People's Republic of China.
Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, South Campus Research Building 4, 1901 East Road, Houston, TX, 77054, USA.
J Transl Med. 2019 Sep 23;17(1):318. doi: 10.1186/s12967-019-2069-y.
BACKGROUND: Only few studies, with small patient cohorts, have evaluated the effect of radiotherapy (RT) for metaplastic breast cancer (MBC). Hence, it is important to investigate the role of RT in MBC survival using a large population-database. METHODS: A retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) from 1973 to 2015 was performed. We compared MBC patients with or without RT for overall survival (OS) and breast cancer-specific survival (BCSS) using univariate and multivariate Cox proportional hazard regressions before and after propensity score matching (PSM). RESULTS: From a total of 2267 patients diagnosed with MBC between 1998 and 2015, 1086 (47.9%) received RT. In the multivariate analysis before PSM, RT provided a better OS (HR 0.73; 95% CI 0.61-0.88; p = 0.001) and BCSS (HR 0.71; 95% CI 0.58-0.88; p = 0.002). Multivariate analyses after PSM (n = 1066) confirmed that patients receiving RT (n = 506) survived longer than those without RT (OS, HR 0.64; 95% CI 0.51-0.80; p < 0.001 and BCSS, HR 0.64; 95% CI 0.50-0.83; p = 0.001). A longer OS was observed when RT was given to older patients (p = 0.001) and in case of large tumor size (p = 0.002). Intriguingly, patients with N0 stage showed better OS after RT (HR 0.69, P = 0.012). CONCLUSIONS: Our findings support the beneficial effect of RT for MBC patients. In particular, older patients or with large tumor size have a greater survival benefit from RT. In conclusion, we have assessed the importance of the use of RT in MBC as survival factor and this could lead to the development of guidelines for this rare sub-type of tumors.
背景:只有少数研究,患者队列规模较小,评估了放疗法(RT)治疗化生性乳腺癌(MBC)的效果。因此,使用大型人群数据库研究 RT 在 MBC 生存中的作用非常重要。
方法:使用 1973 年至 2015 年的监测、流行病学和最终结果(SEER)进行回顾性队列研究。我们通过单变量和多变量 Cox 比例风险回归比较了有和没有 RT 的 MBC 患者的总生存率(OS)和乳腺癌特异性生存率(BCSS),并在倾向评分匹配(PSM)前后进行了比较。
结果:在 1998 年至 2015 年间诊断为 MBC 的 2267 名患者中,有 1086 名(47.9%)接受了 RT。在 PSM 前的多变量分析中,RT 提供了更好的 OS(HR 0.73;95%CI 0.61-0.88;p=0.001)和 BCSS(HR 0.71;95%CI 0.58-0.88;p=0.002)。PSM 后(n=1066)的多变量分析证实,接受 RT(n=506)的患者比未接受 RT 的患者存活时间更长(OS,HR 0.64;95%CI 0.51-0.80;p<0.001 和 BCSS,HR 0.64;95%CI 0.50-0.83;p=0.001)。对于老年患者(p=0.001)和大肿瘤患者(p=0.002),接受 RT 后 OS 更长。有趣的是,N0 期患者接受 RT 后 OS 更好(HR 0.69,p=0.012)。
结论:我们的研究结果支持 RT 对 MBC 患者有益。特别是,老年患者或大肿瘤患者从 RT 中获益更大。总之,我们评估了 RT 作为 MBC 生存因素的重要性,这可能导致为这种罕见的肿瘤亚型制定指南。
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