Zhang Jie, Luo Shiping, Qiu Zhaozhen, Lin Yuxiang, Song Chuangui
Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Front Oncol. 2021 Mar 18;11:625628. doi: 10.3389/fonc.2021.625628. eCollection 2021.
In our study, we aimed to evaluate the role of postoperative radiotherapy for patents with stage IV breast cancer. Patients diagnosed with stage IV breast cancer from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Those patients who received both chemotherapy and surgery and lived longer than 6 months were divided into radiotherapy and non-radiotherapy groups. Kaplan-Meier analysis and multivariate Cox proportional hazards models were used to estimate the survival outcomes before and after being 1:1 propensity score matched (PSM). Subgroup analyses stratified by age, subtype, status of distant metastasis, and surgery type were also performed. Among 1,935 patients, 52% (1006) underwent radiotherapy while the non-radiotherapy group contained 48% (929). After PSM, a total of 1,520 patients in two groups of 760 patients were enrolled in this analysis. Kaplan-Meier and the multivariate survival analysis demonstrated that the radiotherapy group presented with a better prognosis compared to the non-radiotherapy group (after PSM, BCSS: Hazard Ratio, 0.697; 95% confidence interval, 0.59-0.823; < 0.001; OS: Hazard Ratio, 0.707; 95% confidence interval, 0.601-0.831; < 0.001). Further subgroup analyses showed the Luminal subtype (HR+/HER2-), triple-negative breast cancer (TNBC), and bone-only metastasis patients presented with the most promising survival in the radiotherapy group. Postoperative radiotherapy is associated with a significant survival advantages in BCSS and OS. It can be an optimal supplementary treatment for stage IV patients after surgery, especially for Luminal subtype, TNBC, and patients with a low metastatic burden.
在我们的研究中，我们旨在评估术后放疗对IV期乳腺癌患者的作用。从监测、流行病学和最终结果（SEER）数据库中选取了2010年至2016年被诊断为IV期乳腺癌的患者。那些接受了化疗和手术且存活时间超过6个月的患者被分为放疗组和非放疗组。采用Kaplan-Meier分析和多变量Cox比例风险模型来估计1:1倾向评分匹配（PSM）前后的生存结果。还进行了按年龄、亚型、远处转移状态和手术类型分层的亚组分析。在1935例患者中，52%（1006例）接受了放疗，而非放疗组占48%（929例）。PSM后，两组共1520例患者（每组760例）纳入本分析。Kaplan-Meier分析和多变量生存分析表明，与非放疗组相比，放疗组的预后更好（PSM后，BCSS：风险比，0.697；95%置信区间，0.59 - 0.823；P < 0.001；OS：风险比，0.707；95%置信区间，0.601 - 0.831；P < 0.001）。进一步的亚组分析显示，管腔亚型（HR+/HER2-）、三阴性乳腺癌（TNBC）和仅骨转移患者在放疗组中的生存前景最为乐观。术后放疗在BCSS和OS方面具有显著的生存优势。它可以作为IV期患者术后的一种最佳辅助治疗，特别是对于管腔亚型、TNBC和转移负担低的患者。
