Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Breast. 2020 Dec;54:79-87. doi: 10.1016/j.breast.2020.09.003. Epub 2020 Sep 9.
The aim of this study was to explore the value of adjuvant chemotherapy in patients with early-stage ER/PR-positive mucinous carcinoma.
We identified early-stage ER/PR-positive mucinous carcinoma patients in the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity-score matching (PSM) analysis to eliminate selection bias and differences in baseline characteristics. Univariate and multivariate analyses were performed to identify significant prognostic factors. The primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS), which were evaluated with the Kaplan-Meier method.
After propensity score matching, 805 pairs were selected. Patients with early-stage ER/PR-positive mucinous adenocarcinoma in the chemotherapy group had a better OS, but not BCSS, than those in the nonchemotherapy group after PSM (OS: p < 0.001; BCSS: p = 0.285). After stratifying by tumor size and lymph node status, adjuvant chemotherapy could significantly improve the OS of early-stage ER/PR-positive patients with tumors larger than 3 cm (p = 0.004) if they had negative lymph nodes (LNs). For patients positive LNs, the OS was significantly different between the chemotherapy group and the non-chemotherapy group when the tumors were larger than 1 cm (T = 1-2.9 cm, p = 0.006; T＞3 cm, p = 0.049, respectively).
Adjuvant chemotherapy maybe improves prognosis in patients with negative LNs and tumors larger than 3 cm, or patients with LNs metastasis and tumors larger than 1 cm. We suggest considering clinical characteristics meanwhile when deciding chemotherapy or not. Randomized controlled trials (RCT) are expected to confirm our results in the future.
本研究旨在探讨辅助化疗在早期 ER/PR 阳性黏液性癌患者中的应用价值。
我们在 SEER 数据库中确定了早期 ER/PR 阳性黏液性癌患者。我们采用倾向评分匹配（PSM）分析消除选择偏倚和基线特征差异。采用单因素和多因素分析确定显著的预后因素。主要终点是总生存期（OS）和乳腺癌特异性生存期（BCSS），采用 Kaplan-Meier 法评估。
经倾向评分匹配后，共选择了 805 对患者。PSM 后，化疗组早期 ER/PR 阳性黏液性腺癌患者的 OS 优于非化疗组（OS：p＜0.001；BCSS：p＝0.285）。在按肿瘤大小和淋巴结状态分层后，对于肿瘤大于 3cm 的早期 ER/PR 阳性患者，如果淋巴结阴性（LNs），辅助化疗可显著改善 OS（p＝0.004）。对于 LNs 阳性的患者，当肿瘤大于 1cm 时，化疗组和非化疗组的 OS 差异有统计学意义（T＝1-2.9cm，p＝0.006；T＞3cm，p＝0.049）。
辅助化疗可能改善淋巴结阴性且肿瘤大于 3cm 的患者，或淋巴结转移且肿瘤大于 1cm 的患者的预后。我们建议在决定是否化疗时同时考虑临床特征。未来的随机对照试验（RCT）有望证实我们的结果。
