Duke University Medical Center, Department of Surgery, Durham, NC, USA.
Duke Cancer Institute, Durham, NC, USA; Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA; Duke University, Department of Biostatistics & Bioinformatics, Durham, NC, USA.
Am J Surg. 2022 Jan;223(1):81-93. doi: 10.1016/j.amjsurg.2021.07.018. Epub 2021 Jul 22.
We sought to identify characteristics of metastatic breast cancer (MBC) patients who may benefit most from primary tumor resection.
Recursive partitioning analysis (RPA) was used to categorize non-surgical patients with de novo MBC in the NCDB (2010-2015) into 3 groups (I/II/III) based on 3-year overall survival (OS). After bootstrapping (BS), group-level profiles were applied, and the association of surgery with OS was estimated using Cox proportional hazards models.
All patients benefitted from surgery (median OS, surgery vs no surgery): 72.7 vs 42.9 months, 47.3 vs 30.4 months, 23.8 vs 14.4 months (all p < 0.001) in BS-groups I, II, and III, respectively. After adjustment, surgery remained associated with improved OS (HR 0.52, 95% CI 0.50-0.55). The effect of surgery on OS differed quantitatively across groups.
Prognostic groups may inform the degree of benefit from surgery, with the greatest benefit seen in those with the most favorable survival.
我们旨在确定可能从原发肿瘤切除中获益最大的转移性乳腺癌（MBC）患者的特征。
基于 3 年总生存（OS），递归分区分析（RPA）将 NCDB（2010-2015）中初诊为 MBC 的非手术患者分为 3 组（I/II/III）。在引导（BS）后，应用组级分析，使用 Cox 比例风险模型估计手术与 OS 的相关性。
所有患者均从手术中获益（中位 OS，手术 vs 非手术）：BS 组 I、II 和 III 中的 72.7 与 42.9 个月、47.3 与 30.4 个月、23.8 与 14.4 个月（均 p<0.001）。校正后，手术仍与 OS 改善相关（HR 0.52，95%CI 0.50-0.55）。手术对 OS 的影响在组间存在定量差异。
预后分组可以告知手术获益的程度，在生存最有利的患者中获益最大。
