Qian Chao, Liang Yan, Yang Min, Bao Sheng-Nan, Bai Jian-Ling, Yin Yong-Mei, Yu Hao
Department of General Surgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.
Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Gland Surg. 2021 Oct;10(10):2978-2996. doi: 10.21037/gs-21-413.
Breast-conserving surgery followed by radiotherapy is recommended in most women with early-stage unilateral breast cancer. However, its role in contralateral breast cancer (CBC) patients remains unclear. This retrospective study aimed to evaluate the breast cancer-specific survival (BCSS) outcomes after breast-conserving surgery plus radiotherapy compared with mastectomy in women with early-stage (T1-2N0-1M0) CBC.
Data were extracted from the Surveillance, Epidemiology, and End Results database. BCSS was analyzed using the log-rank method, competing risks regression model, and propensity score matching method.
A total of 9,336 early-stage CBC patients were included. After multivariable adjustment, no significant difference in BCSS was found between early-stage CBC patients undergoing breast-conserving surgery plus radiotherapy and those undergoing mastectomy [hazard ratio (HR) 1.11, 95% confidence interval (CI): 0.90-1.37, P=0.329]. BCSS was similar in both treatment groups and in the subgroups stratified by age at first primary breast cancer or CBC diagnosis (≤50, 51-60, and >60 years), time interval between cancers (<0.25, 0.25-4, 5-9, and ≤10 years), stage of first primary breast cancer, T classification of CBC, histology and hormone receptors status of both cancers (all P>0.05). Among patients with N1 disease at CBC diagnosis, breast-conserving surgery plus radiotherapy was associated with a boundary significantly improved BCSS (HR 1.45, 95% CI: 1.00-2.12, P=0.050). Among patients who underwent breast-conserving surgery for first primary cancer, bilateral mastectomy for contralateral cancer did not improve BCSS compared with breast-conserving surgery plus radiotherapy (P>0.05). There was no significant difference in BCSS between breast-conserving surgery plus radiotherapy and mastectomy plus radiotherapy (P>0.05). Stable results were obtained after propensity score matching.
Breast-conserving surgery plus radiotherapy did not significantly influence BCSS outcomes of patients with early-stage CBC. Bilateral mastectomy and mastectomy plus radiotherapy did not confer a survival advantage over breast-conserving surgery plus radiotherapy in these patients. Future prospective studies are necessary to expand on these results.
对于大多数早期单侧乳腺癌女性患者，推荐保乳手术加放疗。然而，其在对侧乳腺癌（CBC）患者中的作用仍不明确。这项回顾性研究旨在评估早期（T1-2N0-1M0）CBC女性患者保乳手术加放疗与乳房切除术相比的乳腺癌特异性生存（BCSS）结局。
数据取自监测、流行病学和最终结果数据库。采用对数秩检验、竞争风险回归模型和倾向评分匹配法分析BCSS。
共纳入9336例早期CBC患者。多变量调整后，接受保乳手术加放疗的早期CBC患者与接受乳房切除术的患者相比，BCSS无显著差异[风险比（HR）1.11，95%置信区间（CI）：0.90-1.37，P=0.329]。两个治疗组以及按首次原发性乳腺癌或CBC诊断时年龄（≤50岁、51-60岁和>60岁）、癌症间隔时间（<0.25年、0.25-4年、5-9年和≤10年）、首次原发性乳腺癌分期、CBC的T分类、两种癌症的组织学和激素受体状态分层的亚组中，BCSS相似（所有P>0.05）。在CBC诊断时为N1疾病的患者中，保乳手术加放疗与显著改善的BCSS相关（HR 1.45，95%CI：1.00-2.12，P=0.050）。在首次原发性癌症接受保乳手术的患者中，对侧癌症行双侧乳房切除术与保乳手术加放疗相比，BCSS未改善（P>0.05）。保乳手术加放疗与乳房切除术加放疗的BCSS无显著差异（P>0.05）。倾向评分匹配后结果稳定。
保乳手术加放疗对早期CBC患者的BCSS结局无显著影响。在这些患者中，双侧乳房切除术和乳房切除术加放疗与保乳手术加放疗相比未显示出生存优势。未来有必要进行前瞻性研究以拓展这些结果。
