Tseng Michelle, Vellayappan Balamurugan, Choong Rachel, Appalanaido Gokula Kumar, Soon Yu Yang
Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore.
School of Medicine, University of Dundee, Scotland, UK.
Transl Cancer Res. 2020 Jan;9(Suppl 1):S23-S28. doi: 10.21037/tcr.2019.07.23.
To determine if PMRT for elderly patients (>65 years old) with intermediate risk breast cancer (T1-2N1, T3N0) improves outcomes.
We performed a systematic review and meta-analysis to compare the effects of PMRT to no PMRT for elderly patients with intermediate-risk breast cancer. We searched PubMed for eligible studies from Jan 2008 to Dec 2018. We assessed the methodological quality of the included studies using the ROBINS-I tool and performed the meta-analysis with random effects model. The primary outcome of interest was overall survival (OS); secondary outcomes were breast cancer specific survival (BCSS), loco-regional (LRR) and distant disease recurrence (DDR).
We found 2 retrospective cohort studies with 743 patients directly comparing PMRT to no PMRT. Both studies were judged to have serious risk of bias in their methodological quality. The pooled results suggest that PMRT was associated with a 20% relative reduction in the hazard in death, ranging from 41% relative reduction, a substantial negative association to 10% relative increase, a small positive association (HR 0.80, 95% CI: 0.59-1.1, P=0.62, I=0%). PMRT was also associated with a 17% relative reduction in the hazard for breast cancer related death, ranging from 52% relative reduction, a substantial negative association to 41% relative increase, a substantial positive association (HR 0.83, 95% CI: 0.48-1.41, P=0.48, I=0%). One study did not observe any significant differences in LRR and DDR between the two groups.
The survival benefits from PMRT in unselected elderly patients with intermediate risk breast cancer is unclear. Further research to better select elderly patients who may benefit from PMRT is warranted. Patients with a multiple pathological risk factors suggestive of high risk of loco-regional recurrence post-mastectomy should consider PMRT.
确定对老年（>65岁）中危乳腺癌（T1-2N1、T3N0）患者进行术后放疗（PMRT）是否能改善预后。
我们进行了一项系统评价和荟萃分析，以比较PMRT与非PMRT对老年中危乳腺癌患者的效果。我们在PubMed上检索了2008年1月至2018年12月的符合条件的研究。我们使用ROBINS-I工具评估纳入研究的方法学质量，并采用随机效应模型进行荟萃分析。主要关注的结局是总生存期（OS）；次要结局是乳腺癌特异性生存期（BCSS）、局部区域复发（LRR）和远处疾病复发（DDR）。
我们发现2项回顾性队列研究，共743例患者，直接比较了PMRT与非PMRT。两项研究在方法学质量上均被判定存在严重偏倚风险。汇总结果表明，PMRT与死亡风险相对降低20%相关，范围从相对降低41%（显著负相关）到相对增加10%（小的正相关）（HR 0.80，95%CI：0.59-1.1，P=0.62，I=0%）。PMRT还与乳腺癌相关死亡风险相对降低17%相关，范围从相对降低52%（显著负相关）到相对增加41%（显著正相关）（HR 0.83，95%CI：0.48-1.41，P=0.48，I=0%）。一项研究未观察到两组之间在LRR和DDR方面有任何显著差异。
在未经选择的老年中危乳腺癌患者中，PMRT的生存获益尚不清楚。有必要进一步研究以更好地选择可能从PMRT中获益的老年患者。具有多种提示乳房切除术后局部区域复发高风险的病理危险因素的患者应考虑进行PMRT。
