保乳手术后追加放疗是新诊断 IV 期乳腺癌的一种可选治疗方法：基于人群的分析。

Additional radiotherapy to breast-conserving surgery is an optional treatment for de novo stage IV breast cancer: A population-based analysis.

机构信息

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.

Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Medical University), Haikou, Hainan, People's Republic of China.

出版信息

Cancer Med. 2021 Mar;10(5):1634-1643. doi: 10.1002/cam4.3751. Epub 2021 Feb 14.

DOI:10.1002/cam4.3751

PMID:33586323

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7940213/

Abstract

BACKGROUND

We aim to assess the value of locoregional treatment (LRT) including breast-conserving surgery (BCS), mastectomy (MAST), and radiotherapy (RT) in patients with de novo stage IV breast cancer.

METHODS

Patients with de novo stage IV breast cancer were retrospectively identified from the Surveillance, Epidemiology, and End Results database between 2004 and 2014. Kaplan-Meier analysis, log-rank tests, propensity score matching (PSM), and the multivariate Cox proportional model were used for statistical analysis.

RESULTS

A total of 5798 patients were identified including 849 (14.6%), 763 (13.2%), 2338 (40.3%), and 1848 (31.9%) who received BCS alone, BCS+RT, MAST alone, and MAST+RT, respectively. The proportions of receiving BCS decreased from 35.9% in 2004 to 26.2% in 2014 (p = 0.002), and the probability of patients receiving MAST increased from 64.1% in 2004 to 74.8% in 2014 (p = 0.002). Before PSM, there was a significant difference in breast cancer-specific survival (BCSS) among the treatment arms. Patients who received RT had better BCSS, the 5-year BCSS was 40.5%, 52.3%, 41.5%, and 47.7% in patients treated with BCS alone, BCS+RT, MAST alone, and MAST+RT, respectively (p < 0.001). In the PSM cohort, patients treated with BCS alone had lower 5-year BCSS compared to those treated with BCS+RT (43.9% and 52.1%, p = 0.002). However, there were comparable 5-year BCSS between BCS+RT and MAST alone groups (51.3% and 50.1%, p = 0.872), and BCS+RT and MAST+RT cohorts (51.5% and 55.7%, p = 0.333). Similar results were confirmed in multivariate analysis.

CONCLUSIONS

Postoperative RT improves BCSS in patients with de novo stage IV breast cancer, and BCS+RT shows a non-inferior outcome compared to MAST+RT. BCS+RT may be the optimal local management of de novo stage IV breast cancer.

摘要

背景

我们旨在评估包括保乳手术（BCS）、乳房切除术（MAST）和放疗（RT）在内的局部区域治疗（LRT）在新发 IV 期乳腺癌患者中的价值。

方法

从 2004 年至 2014 年，我们从监测、流行病学和最终结果数据库中回顾性确定了新发 IV 期乳腺癌患者。使用 Kaplan-Meier 分析、对数秩检验、倾向评分匹配（PSM）和多变量 Cox 比例模型进行统计分析。

结果

共确定了 5798 例患者，分别接受了单纯 BCS（849 例，14.6%）、BCS+RT（763 例，13.2%）、MAST 单独治疗（2338 例，40.3%）和 MAST+RT（1848 例，31.9%）。2004 年接受 BCS 的比例为 35.9%，2014 年降至 26.2%（p=0.002），接受 MAST 的患者比例从 2004 年的 64.1%增加到 2014 年的 74.8%（p=0.002）。在 PSM 之前，不同治疗组之间的乳腺癌特异性生存（BCSS）存在显著差异。接受 RT 的患者 BCSS 更好，单纯 BCS 治疗、BCS+RT、MAST 单独治疗和 MAST+RT 的 5 年 BCSS 分别为 40.5%、52.3%、41.5%和 47.7%（p<0.001）。在 PSM 队列中，与接受 BCS+RT 的患者相比，单独接受 BCS 治疗的患者 5 年 BCSS 较低（分别为 43.9%和 52.1%，p=0.002）。然而，BCS+RT 组与 MAST 单独治疗组的 5 年 BCSS 相当（分别为 51.3%和 50.1%，p=0.872），BCS+RT 组与 MAST+RT 组的 5 年 BCSS 相当（分别为 51.5%和 55.7%，p=0.333）。多变量分析也证实了相似的结果。