辅助化疗不能给 HR 阳性、HER2 阴性、pT1b-c/N0-1/M0 期浸润性小叶癌患者带来生存获益：基于 SEER 数据库的倾向评分匹配研究。
Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0-1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database.
机构信息
Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Binzhong People's Hospital, Affiliated to First Shandong Medical University, Binzhong, China.
出版信息
BMC Cancer. 2020 Feb 21;20(1):136. doi: 10.1186/s12885-020-6614-0.
BACKGROUND
The benefit of adjuvant chemotherapy in invasive lobular carcinoma (ILC) is still unclear. The objective of the current study was to elucidate the effectiveness of adjuvant chemotherapy in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1b-c/N0-1/M0 ILC.
METHODS
Based on Surveillance, Epidemiology, and End-Results (SEER) database, we identified original 12,334 HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC patients, who were then divided into adjuvant chemotherapy group and control group. End-points were overall survival (OS) and breast cancer-specific mortality (BCSM). Aiming to minimize the selection bias of baseline characteristics, Propensity Score Matching (PSM) method was used.
RESULTS
In a total of 12,334 patients with HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC, 1785 patients (14.5%) were allocated into adjuvant chemotherapy group and 10,549 (85.5%) into control group. Used PSM, the 1785 patients in adjuvant chemotherapy group matched to the 1785 patients in control group. By Kaplan-Meier survival analyses, we observed no beneficial effect of adjuvant chemotherapy on OS in both original samples (P = 0.639) and matched samples (P = 0.962), however, ineffective or even contrary results of adjuvant chemotherapy on BCSM both in original samples (P = 0.001) and in matched samples (P = 0.002). In both original and matched multivariate Cox models, we observed ineffectiveness of adjuvant chemotherapy on OS (hazard ratio (HR) for overall survival = 0.82, 95% confidence interval (CI) [0.62-1.09]; P = 0.172 and HR = 0.90, 95%CI [0.65-1.26]; P = 0.553, respectively), unexpectedly promoting effect of adjuvant chemotherapy on BCSM (HR = 2.33, 95%CI [1.47-3.67]; P = 0.001 and HR = 2.41, 95%CI [1.32-4.39]; P = 0.004, respectively). Standard surgery was beneficial to the survival of patients. Lymph node metastasis was detrimental to survival and radiotherapy brought survival benefit in original samples, but two issues had unobvious effect in matched samples.
CONCLUSION
In this study, adjuvant chemotherapy did not improve survival for patients with HR-positive, HER2-negative pT1b-c/N0-1/M0 ILC.
背景
辅助化疗对浸润性小叶癌（ILC）的益处仍不清楚。本研究的目的是阐明激素受体（HR）阳性、人表皮生长因子受体 2（HER2）阴性、pT1b-c/N0-1/M0 ILC 患者接受辅助化疗的效果。
方法
基于监测、流行病学和最终结果（SEER）数据库，我们确定了 12334 名 HR 阳性、HER2 阴性、pT1b-c/N0-1/M0 ILC 患者，然后将他们分为辅助化疗组和对照组。终点是总生存期（OS）和乳腺癌特异性死亡率（BCSM）。为了最大限度地减少基线特征的选择偏差，使用了倾向评分匹配（PSM）方法。
结果
在总共 12334 名 HR 阳性、HER2 阴性、pT1b-c/N0-1/M0 ILC 患者中，1785 名（14.5%）患者被分配到辅助化疗组，10549 名（85.5%）患者被分配到对照组。使用 PSM，辅助化疗组的 1785 名患者与对照组的 1785 名患者相匹配。通过 Kaplan-Meier 生存分析，我们在原始样本（P=0.639）和匹配样本（P=0.962）中均未观察到辅助化疗对 OS 的有益影响，但在原始样本（P=0.001）和匹配样本（P=0.002）中均观察到辅助化疗对 BCSM 无效甚至相反的结果。在原始和匹配的多变量 Cox 模型中，我们观察到辅助化疗对 OS 无效（总生存的风险比（HR）=0.82，95%置信区间（CI）[0.62-1.09]；P=0.172 和 HR=0.90，95%CI [0.65-1.26]；P=0.553），出乎意料的是，辅助化疗对 BCSM 有促进作用（HR=2.33，95%CI [1.47-3.67]；P=0.001 和 HR=2.41，95%CI [1.32-4.39]；P=0.004）。标准手术对患者的生存有益。淋巴结转移对生存不利，放疗在原始样本中带来生存获益，但这两个问题在匹配样本中影响不明显。
结论
在这项研究中，辅助化疗并未改善 HR 阳性、HER2 阴性 pT1b-c/N0-1/M0 ILC 患者的生存。
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