保乳手术加放疗与早期乳腺癌全乳切除术的生存比较。

Survival of Breast-Conserving Surgery Plus Radiotherapy versus Total Mastectomy in Early Breast Cancer.

机构信息

Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Ann Surg Oncol. 2021 Sep;28(9):5039-5047. doi: 10.1245/s10434-021-09591-x. Epub 2021 Jan 25.

DOI:10.1245/s10434-021-09591-x

PMID:33492542

Abstract

BACKGROUND

Breast-conserving surgery (BCS) has been reported to have better survival rates when compared with total mastectomy (TM) in early breast cancer. We evaluated the long-term outcomes of Korean women with early breast cancer who underwent either BCS plus radiotherapy (RT) or TM.

METHODS

In this population-based study, we evaluated 45,770 patients from the Korean Breast Cancer Registry (KBCR) who were diagnosed with early breast cancer, and divided them into the BCS + RT and TM groups. To minimize bias caused by factors other than the surgical method, we used exact match pairing of prognostic factors. We compared the 10-year overall survival (OS) and breast cancer-specific survival (BCSS) before and after exact matching. As the KBCR is a multicenter, online-based registry program, we used the Asan Medical Center (AMC) database, a single-center database, to validate the results from the KBCR database.

RESULTS

In both the KBCR and AMC cohorts, the BCS + RT group showed better OS and BCSS than the TM group, before and after exact matching. For the KBCR cohort after exact matching, the hazard ratios for OS and BCSS were 1.541 (95% confidence interval [CI] 1.392-1.707, p < 0.001) and 1.405 (95% CI 1.183-1.668, p < 0.001), respectively, favoring the BCS + RT group. For the AMC cohort after exact matching, the hazard ratios for OS and BCSS were 1.854 (95% CI 1.476-2.328, p < 0.001) and 1.807 (95% CI 1.186-2.752, p = 0.006), respectively.

CONCLUSIONS

Our results suggest that BCS + RT is at least equivalent to TM in terms of OS and may affect treatment decisions in early breast cancer patients.

摘要

背景

与全乳切除术（TM）相比，保乳手术（BCS）在早期乳腺癌患者中的生存率更高。我们评估了接受 BCS 加放疗（RT）或 TM 的韩国早期乳腺癌女性的长期结果。

方法

在这项基于人群的研究中，我们从韩国乳腺癌登记处（KBCR）评估了 45770 名诊断为早期乳腺癌的患者，并将他们分为 BCS+RT 和 TM 组。为了将手术方法以外的因素造成的偏倚降到最低，我们使用了预后因素的精确匹配配对。我们比较了精确匹配前后 10 年的总生存率（OS）和乳腺癌特异性生存率（BCSS）。由于 KBCR 是一个多中心、在线注册计划，我们使用了单中心数据库 Asan 医疗中心（AMC）数据库来验证 KBCR 数据库的结果。

结果

在 KBCR 和 AMC 队列中，BCS+RT 组在精确匹配前后的 OS 和 BCSS 均优于 TM 组。对于精确匹配后的 KBCR 队列，OS 和 BCSS 的风险比分别为 1.541（95%置信区间 [CI] 1.392-1.707，p<0.001）和 1.405（95% CI 1.183-1.668，p<0.001），有利于 BCS+RT 组。对于精确匹配后的 AMC 队列，OS 和 BCSS 的风险比分别为 1.854（95% CI 1.476-2.328，p<0.001）和 1.807（95% CI 1.186-2.752，p=0.006）。