Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, USA; Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, USA.
Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, USA.
Breast. 2021 Dec;60:185-191. doi: 10.1016/j.breast.2021.10.005. Epub 2021 Oct 15.
Locoregional therapy at primary or secondary sites in breast cancer may be associated with improved survival as compared to systemic therapy alone. We explored the sociodemographic and clinicopathologic factors associated with the use of radiation versus surgical resection of metastatic sites (metastasectomy) in patients with de novo stage IV breast cancer, followed by the associated overall survival.
We sampled the National Cancer Database for patients with de novo stage IV breast cancer, (2010-2017) and described cohort's characteristics using univariate analyses. We identified 5 subgroups based on malignant site involvement: 1. Bone only, 2. Brain only, 3. Liver only, 4. Lung only, and 5. Metastasis involving >1 site. Kaplan-Meier modeling with log-rank testing and multivariate Cox Regression analysis were used to explore differences in overall survival between those that received radiation at secondary sites and those that underwent metastasectomy.
N = 22,749patients were included in this analysis. Radiation (81.2%) was used more commonly than metastasectomy (28.8%). Metastasectomy was associated with better median overall survival across all 5 cohorts (p < .001), with the survival benefit being the most pronounced with lung only (OS: 56.9 months; HR 0.8, 95% CI 0.7-0.9, p = .032), or liver only (OS: 41.6 months; HR: 0.9; 95% CI: 0.7-1.1, p < .001) metastasis.
Metastasectomy in patients with de novo stage IV breast cancer may be associated with improved overall survival as compared to radiation of secondary lesions, particularly in those with only liver or lung involvement. Prospective randomized controlled trials investigating surgical resection of metastatic sites in patients with breast cancer are warranted.
与单独全身治疗相比，乳腺癌原发或继发部位的局部区域治疗可能与改善生存相关。我们探讨了与新诊断为 IV 期乳腺癌患者转移性病变（转移灶切除术）中使用放射治疗与手术切除相关的社会人口学和临床病理因素，以及与总生存相关的因素。
我们从国家癌症数据库中抽取了新诊断为 IV 期乳腺癌的患者（2010-2017 年），并使用单变量分析描述队列的特征。我们根据恶性肿瘤部位的受累情况将患者分为 5 个亚组：1. 仅骨转移，2. 仅脑转移，3. 仅肝转移，4. 仅肺转移，5. 转移灶累及 >1 个部位。采用 Kaplan-Meier 模型进行对数秩检验和多变量 Cox 回归分析，以探讨接受继发部位放疗和接受转移灶切除术的患者总生存之间的差异。
本研究共纳入 22749 例患者。放疗（81.2%）的应用比转移灶切除术（28.8%）更为常见。转移灶切除术与所有 5 个队列的中位总生存时间均延长相关（p<0.001），且仅肺转移（OS：56.9 个月；HR 0.8，95%CI 0.7-0.9，p=0.032）或仅肝转移（OS：41.6 个月；HR：0.9；95%CI：0.7-1.1，p<0.001）的生存获益最为显著。
与放疗继发部位相比，新诊断为 IV 期乳腺癌患者的转移灶切除术可能与总生存改善相关，特别是仅肝或肺转移的患者。需要开展前瞻性随机对照试验，以评估乳腺癌患者转移灶切除术的疗效。
