Tamirisa Nina P, Ren Yi, Campbell Brittany M, Thomas Samantha M, Fayanju Oluwadamilola M, Plichta Jennifer K, Rosenberger Laura H, Force Jeremy, Hyslop Terry, Hwang E Shelley, Greenup Rachel A
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Duke Cancer Institute, Durham, NC, USA.
Ann Surg Oncol. 2021 Apr;28(4):2146-2154. doi: 10.1245/s10434-020-09024-1. Epub 2020 Sep 18.
In 2002, breast cancer patients with supraclavicular nodal metastases (cN3c) were downstaged from AJCC stage IV to IIIc, prompting management with locoregional treatment. We sought to estimate the impact of multimodal therapy on overall survival (OS) in a contemporary cohort of cN3c patients.
Women ≥ 18 years with cT1-T4c/cN3c invasive breast cancer who underwent systemic therapy were identified from the 2004-2016 National Cancer Database. We compared three patient cohorts: (a) cN3c + multimodal therapy (systemic therapy, surgery, and radiation); (b) cN3c + non-standard therapy; and, (c) cM1. Logistic regression identified factors associated with receipt of multimodal therapy and Kaplan-Meier was used to estimate unadjusted OS. The Cox proportional hazards model estimated effects of diagnosis and treatment on OS after adjustment.
Overall, 1827 (3.7%) patients with cN3c disease and 46,919 (96.3%) cM1 patients were identified. Of cN3c patients, 74.5% (n = 1362) received multimodal therapy and 25.5% (n = 465) received non-standard therapy; receipt of multimodal therapy was associated with improved 5-year OS (multimodal: 59% vs. M1: 28% vs. non-standard: 28%, log-rank p < 0.001). Adjusting for covariates, non-standard therapy was associated with an increased risk of death compared with receipt of multimodal therapy (HR 2.20, 95% CI 1.71-2.83, p < 0.001). Private insurance was the only patient characteristic associated with a greater likelihood of receiving multimodal therapy (OR 2.81; 95% CI, 1.64-4.82; p < 0.001).
Women with cN3c breast cancer who received multimodal therapy demonstrated improved overall survival when compared with patients undergoing non-standard therapy and those with metastatic (M1) disease. Although selection bias may contribute to worse overall survival among cN3c patients undergoing non-standard therapy, national guidelines should encourage locoregional treatment in carefully selected patients.
2002年，伴有锁骨上淋巴结转移（cN3c）的乳腺癌患者从美国癌症联合委员会（AJCC）分期IV期降为IIIc期，促使采用局部区域治疗。我们试图评估多模式治疗对当代cN3c患者队列总生存期（OS）的影响。
从2004 - 2016年国家癌症数据库中识别出年龄≥18岁、患有cT1 - T4c/cN3c浸润性乳腺癌且接受过全身治疗的女性。我们比较了三个患者队列：（a）cN3c + 多模式治疗（全身治疗、手术和放疗）；（b）cN3c + 非标准治疗；以及（c）cM1。逻辑回归确定与接受多模式治疗相关的因素，并使用Kaplan - Meier法估计未经调整的总生存期。Cox比例风险模型估计诊断和治疗对调整后总生存期的影响。
总体上，识别出1827例（3.7%）cN3c疾病患者和46919例（96.3%）cM1患者。在cN3c患者中，74.5%（n = 1362）接受了多模式治疗，25.5%（n = 465）接受了非标准治疗；接受多模式治疗与5年总生存期改善相关（多模式治疗：59% vs. M1：28% vs. 非标准治疗：28%，对数秩检验p < 0.001）。在对协变量进行调整后，与接受多模式治疗相比，非标准治疗与死亡风险增加相关（风险比2.20，95%置信区间1.7
