Department of Breast Disease, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China.
Breast Cancer Res Treat. 2020 Jul;182(1):117-126. doi: 10.1007/s10549-020-05686-3. Epub 2020 May 19.
The prognosis of elderly patients with hormone receptor-positive breast cancer is very good, and their survival is unaffected by performing breast-conserving surgery (BCS) without radiotherapy. Therefore, we aimed to verify that BCS without axillary lymph node dissection, sentinel lymph node biopsy, or radiotherapy (BCSNR) is safe for patients over 70 years of age with luminal-type breast cancer, as well as for those with HER2-positive and triple negative breast cancer (TNBC).
This study retrospectively included 450 patients > 70-year-old with breast cancer from 2010 to 2016. The patients were divided into two groups, one treated with BCSNR and the other treated with mastectomy and axillary lymph node dissection (MALND), with a median follow-up period of 5 years. Disease-free survival (DFS), overall survival, local recurrence, distant metastasis, and ipsilateral breast tumor recurrence (IBTR) were compared between the two groups.
The 5-year DFS for patients who underwent BCSNR and MALND was 90.1 and 91.3% (p = 0.903), respectively. In the BCSNR and MALND groups, respectively, the 5-year DFS for patients with luminal A type breast cancer was 99.2 and 100% (p = 0.167), that for patients with luminal B type breast cancer was 89.2 and 95.5% (p = 0.138), that for patients with HER2-positive breast cancer was 86.7 and 75.9% (p = 0.455), and that for TNBC patients was 71.7 and 89.7% (p = 0.195). IBTR significantly differed between the BCSNR and MALND groups for patients with TNBC (18.9% vs 0.0%, p = 0.040) and luminal B type patients (5.6% vs 0.0%, p = 0.043).
BCSNR is not only suitable for elderly patients with luminal-type breast cancer but also for those with HER2-positive breast cancer and TNBC.
激素受体阳性乳腺癌老年患者的预后非常好，并且如果不进行保乳手术（BCS）联合放疗，其生存也不会受到影响。因此，我们旨在验证对于 luminal 型乳腺癌、HER2 阳性乳腺癌和三阴性乳腺癌（TNBC）患者，不进行腋窝淋巴结清扫、前哨淋巴结活检和放疗的保乳手术（BCSNR）是安全的。
本研究回顾性纳入了 2010 年至 2016 年间 450 名年龄大于 70 岁的乳腺癌患者。患者分为两组，一组接受 BCSNR 治疗，另一组接受乳房切除术和腋窝淋巴结清扫（MALND）治疗，中位随访时间为 5 年。比较两组患者的无病生存率（DFS）、总生存率、局部复发、远处转移和同侧乳房肿瘤复发（IBTR）。
BCSNR 组和 MALND 组患者的 5 年 DFS 分别为 90.1%和 91.3%（p=0.903）。在 BCSNR 组和 MALND 组中，luminal A 型乳腺癌患者的 5 年 DFS 分别为 99.2%和 100%（p=0.167），luminal B 型乳腺癌患者的 5 年 DFS 分别为 89.2%和 95.5%（p=0.138），HER2 阳性乳腺癌患者的 5 年 DFS 分别为 86.7%和 75.9%（p=0.455），TNBC 患者的 5 年 DFS 分别为 71.7%和 89.7%（p=0.195）。在 TNBC 患者（18.9% vs 0.0%，p=0.040）和 luminal B 型患者（5.6% vs 0.0%，p=0.043）中，BCSNR 组与 MALND 组的 IBTR 差异有统计学意义。
BCSNR 不仅适用于 luminal 型乳腺癌老年患者，也适用于 HER2 阳性乳腺癌和 TNBC 患者。
