Chen Maoshan, Huang Yunhui, Leng Zhengwei, Yang Guanglun, Li Fangfang, Yang Hongwei, Hou Lingmi
Department of Breast Surgery, Suining Central Hospital, Suining, China.
Department of Breast and Thyroid Surgery, Hepatobiliary and Pancreatic Institution, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Front Oncol. 2020 Feb 14;9:1551. doi: 10.3389/fonc.2019.01551. eCollection 2019.
Whether post-mastectomy radiotherapy (PMRT) could improve prognosis for T1-2 breast cancer patients with one to three lymph node metastases remains controversial. The present study aimed to determine the significance of PMRT in patients with T1-2N1M0 breast cancer. Data of 45,646 patients from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed; 12,585 matched patients were divided into a PMRT group and non-radiotherapy group (no-PMRT), respectively, using the propensity score matching method. Univariate and multivariate analyses were performed to determine the prognostic factors of breast cancer, and subgroup analysis was performed according to the number of lymph node metastases. With the median follow-up of 62 months, 5-year cancer-specific survival was 91.48% in the PMRT group and 91.88% in the no-PMRT group ( = 0.405). PMRT did not improve the breast cancer-specific survival (BCSS) in patients with stage T1-2N1M0 (HR = 0.99, 95% CI = 0.92-1.06, = 0.715). In subgroup analysis, radiotherapy improved the BCSS in patients with three nodes positive, with the 5-year BCSS at 88.5% in the radiation group and 86.6% in the no-radiation group (HR = 0.78, 95% CI = 0.65-0.90, < 0.001). In patients with two nodes positive, 5-year BCSS was 90.3% in the PMRT group and 89.5% in the no-PMRT group, with no significant difference between the two groups (HR = 0.96, 95% CI = 0.85-1.09, = 0.552). In patients with one node positive, 5-year BCSS was higher in the no-PMRT group (92.1%) than that in the PMRT group (90.8%); radiotherapy increased the cancer-related death compared with those who did not receive it (HR = 1.21, 95% CI = 1.08-1.36, = 0.002). The benefit of PMRT in T1-2N1M0 patients was obviously different, and the recommendation of PMRT for this population should be individualized. PMRT should be considered for patients with three nodes positive, should be suggested cautiously in those with two nodes positive, and could be omitted in those with one node positive.
乳房切除术后放疗（PMRT）能否改善T1-2期伴有1至3个淋巴结转移的乳腺癌患者的预后仍存在争议。本研究旨在确定PMRT在T1-2N1M0期乳腺癌患者中的意义。分析了监测、流行病学和最终结果（SEER）数据库中45646例患者的数据；采用倾向评分匹配法将12585例匹配患者分别分为PMRT组和非放疗组（无PMRT组）。进行单因素和多因素分析以确定乳腺癌的预后因素，并根据淋巴结转移数量进行亚组分析。中位随访62个月，PMRT组的5年癌症特异性生存率为91.48%，无PMRT组为91.88%（P=0.405）。PMRT并未改善T1-2N1M0期患者的乳腺癌特异性生存率（BCSS）（风险比[HR]=0.99，95%置信区间[CI]=0.92-1.06，P=0.715）。在亚组分析中，放疗改善了3个淋巴结阳性患者的BCSS，放疗组的5年BCSS为88.5%，非放疗组为86.6%（HR=0.78，95%CI=0.65-0.90，P<0.001）。在2个淋巴结阳性的患者中，PMRT组的5年BCSS为90.3%，无PMRT组为89.5%，两组之间无显著差异（HR=0.96，95%CI=0.85-1.09，P=0.552）。在1个淋巴结阳性的患者中，无PMRT组的5年BCSS（92.1%）高于PMRT组（90.8%）；与未接受放疗的患者相比，放疗增加了癌症相关死亡（HR=1.21，95%CI=1.08-1.36，P=0.002）。PMRT对T1-2N1M0期患者的益处明显不同，对于该人群PMRT的推荐应个体化。3个淋巴结阳性的患者应考虑进行PMRT，2个淋巴结阳性的患者应谨慎建议，1个淋巴结阳性的患者可省略。
