Department of Radiation Oncology, Boston Medical Center, Boston, MA; Present affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
Department of Radiation Oncology, Boston Medical Center, Boston, MA.
Clin Breast Cancer. 2020 Apr;20(2):e200-e213. doi: 10.1016/j.clbc.2019.12.010. Epub 2020 Jan 14.
Although systemic therapy is the standard treatment for metastatic breast cancer, the value of locoregional treatment (LRT) of the primary tumor and its impact on survival is controversial. This study evaluates survival outcomes in patients with metastatic breast cancer after receiving LRT (surgery and/or radiation therapy) of the primary tumor.
The National Cancer Database was used to identify 16,128 qualifying cases of metastatic breast cancer who received systemic therapy with or without LRT from 2004 to 2013. Treatment modality was divided into surgery (Sx), radiation therapy (RT), surgery followed by RT (Sx + RT), and no LRT. The median survival and 3-year actuarial survival rates (OS) were analyzed for each treatment group. On multivariate analyses, adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox regression modeling to adjust for patient and clinicopathologic characteristics.
Overall, the median follow-up was 28.3 months, and the median survival for all patients was 37.2 months. With 9761 deaths reported, the estimated 3-year OS was 51.3%. The Sx + RT group (n = 2166) had the highest 3-year OS of 69.4%, followed by the Sx group (n = 4293) with 57.6%, the no LRT group (n = 8955) with 44.3%, and the RT group (n = 714) with 41.5% (P < .0001). On multivariate analysis, compared with the no LRT group, a decreased HR was noted in patients receiving Sx (adjusted HR, 0.68; 95% CI, 0.65-0.71; P < .0001) and Sx + RT (adjusted HR, 0.46; 95% CI, 0.43-0.49; P < .0001).
LRT, especially surgery followed by RT, in addition to systemic therapy, was associated with improved survival in patients with metastatic breast cancer.
虽然系统治疗是转移性乳腺癌的标准治疗方法，但局部区域治疗（LRT）原发肿瘤的价值及其对生存的影响仍存在争议。本研究评估了接受原发肿瘤 LRT（手术和/或放射治疗）的转移性乳腺癌患者的生存结果。
使用国家癌症数据库，从 2004 年至 2013 年，确定了 16128 例符合条件的转移性乳腺癌患者，这些患者接受了系统治疗，包括或不包括 LRT。治疗方式分为手术（Sx）、放射治疗（RT）、手术加 RT（Sx+RT）和无 LRT。分析每个治疗组的中位生存时间和 3 年生存率（OS）。在多变量分析中，使用 Cox 回归模型调整患者和临床病理特征后，计算调整后的危险比（HR）及其 95%置信区间（CI）。
总体而言，中位随访时间为 28.3 个月，所有患者的中位生存时间为 37.2 个月。报告了 9761 例死亡，估计 3 年 OS 为 51.3%。Sx+RT 组（n=2166）的 3 年 OS 最高，为 69.4%，其次是 Sx 组（n=4293），为 57.6%，无 LRT 组（n=8955），为 44.3%，RT 组（n=714），为 41.5%（P<0.0001）。多变量分析显示，与无 LRT 组相比，接受 Sx（调整 HR，0.68；95%CI，0.65-0.71；P<0.0001）和 Sx+RT（调整 HR，0.46；95%CI，0.43-0.49；P<0.0001）治疗的患者 HR 降低。
除系统治疗外，LRT，特别是手术加 RT，与转移性乳腺癌患者的生存改善相关。
