Huang Zhou, Zhu Li, Huang Xiao-Bo, Tang Yu, Rong Qing-Lin, Shi Mei, Wang Wei-Hu, Tie Jian, Shen Liang-Fang, Chen Jia-Yi, Zhang Jun, Wu Hong-Fen, Cheng Jing, Liu Min, Tan Yu-Ting, Ma Chang-Ying, Wang Shu-Lian, Li Ye-Xiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Int J Radiat Oncol Biol Phys. 2020 Nov 15;108(4):1030-1039. doi: 10.1016/j.ijrobp.2020.06.028. Epub 2020 Jun 23.
The present study aimed to evaluate the effect of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy in patients with node-positive stage II to III (cT1-4N1-2M0) breast cancer.
A total of 1813 patients from 12 institutions were retrospectively reviewed. Patients were classified into 1 of 3 groups based on the pathologic lymph node status after neoadjuvant chemotherapy: ypN0, ypN1, and ypN2-3. The role of PMRT was separately evaluated in each group. Locoregional control, disease-free survival, and overall survival (OS) were estimated using the Kaplan-Meier method. The effect of PMRT was assessed by propensity score-matched analyses and multivariate Cox analyses.
With a median follow-up of 72.9 months, 5-year locoregional control, disease-free survival, and OS rates were 86.3%, 68.4%, and 83.1% for the entire cohort, respectively. There were 490 (27.0%), 567 (31.3%), and 756 (41.7%) patients in the ypN0, ypN1, and ypN2-3 groups, respectively. PMRT significantly improved 5-year OS in the ypN2-3 group (74.2% vs 55.9%; P < .001) but had no effect on 5-year OS in the ypN0 group (93.1% vs 95.5%; P = .517) and ypN1 group (88.4% vs 87.8%; P = .549).
With modern systemic therapy, PMRT significantly improved OS in the ypN2-3 group but not in the ypN0 and ypN1 groups. Whether PMRT can be safely omitted in the ypN0 and ypN1 groups should be addressed prospectively.
本研究旨在评估新辅助化疗后，对II至III期（cT1 - 4N1 - 2M0）淋巴结阳性乳腺癌患者进行乳房切除术后放疗（PMRT）的效果。
对来自12家机构的1813例患者进行回顾性分析。根据新辅助化疗后的病理淋巴结状态，将患者分为3组之一：ypN0、ypN1和ypN2 - 3。分别评估每组中PMRT的作用。采用Kaplan - Meier法估计局部区域控制率、无病生存率和总生存率（OS）。通过倾向评分匹配分析和多因素Cox分析评估PMRT的效果。
中位随访72.9个月，整个队列的5年局部区域控制率、无病生存率和总生存率分别为86.3%、68.4%和83.1%。ypN0组、ypN1组和ypN2 - 3组分别有490例（27.0%）、567例（31.3%）和756例（41.7%）患者。PMRT显著提高了ypN2 - 3组的5年总生存率（74.2%对55.9%；P < 0.001），但对ypN0组（93.1%对95.5%；P = 0.517）和ypN1组（88.4%对87.8%；P = 0.549）的5年总生存率无影响。
在现代全身治疗的情况下，PMRT显著提高了ypN2 - 3组的总生存率，但在ypN0组和ypN1组中未提高。ypN0组和ypN1组是否可以安全地省略PMRT应进行前瞻性研究。
