乳腺癌术后放疗联合或序贯激素治疗后间质性肺疾病：日本全国数据库研究。

Interstitial lung disorders following postoperative radiotherapy with concurrent or sequential hormonal therapy for breast cancer: a nationwide database study in Japan.

机构信息

Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

出版信息

Breast Cancer. 2022 Jul;29(4):688-697. doi: 10.1007/s12282-022-01346-0. Epub 2022 Feb 26.

DOI:10.1007/s12282-022-01346-0

PMID:35217987

Abstract

BACKGROUND

Hormonal therapy and radiotherapy are conducted concurrently or sequentially after breast cancer surgery. It remains unclear whether concurrent or sequential treatment is safer in terms of lung complications. Using a Japanese nationwide database, this study aimed to compare the occurrence of severe lung complications between concurrent and sequential treatments.

METHODS

We identified patients who underwent partial mastectomy for stage 0-III breast cancer from July 2010 to March 2020 and received adjuvant hormonal therapy and radiotherapy concurrently (n = 1851) or sequentially (n = 18,429). Two propensity score analyses (1:4 matching and overlap weighting) were conducted to compare hospitalization for radiation pneumonitis and pneumonia within 1 year after surgery, and intensive care unit admission and mortality during the hospitalization. We conducted additional analyses stratified by hormonal drugs (aromatase inhibitors and tamoxifen).

RESULTS

The propensity score-matched analysis showed no significant differences in occurrence of hospitalization for radiation pneumonitis (0.27 vs. 0.58%, p = 0.10) and pneumonia (0.16 vs. 0.58%, p = 0.05) between the concurrent and sequential treatments. The overlap propensity score-weighted analysis also showed no significant differences (0.25 vs. 0.56%, p = 0.08 and 0.15 vs. 0.44%, p = 0.06, respectively). Intensive care unit admission and in-hospital mortality did not differ significantly between the two treatments. The stratified analysis showed similar results.

CONCLUSION

Our propensity score analyses revealed no significant differences in severe lung complications between concurrent and sequential hormonal therapy with radiotherapy following breast cancer surgery, regardless of the type of hormonal drugs. Clinicians can provide concurrent or sequential treatment with equivalent attention to early lung complications.

摘要

背景

乳腺癌手术后，同时或序贯进行激素治疗和放疗。目前尚不清楚在肺部并发症方面，同时治疗还是序贯治疗更安全。本研究利用日本全国性数据库，旨在比较同时和序贯治疗发生严重肺部并发症的情况。

方法

我们从 2010 年 7 月至 2020 年 3 月间，确定了接受保乳术治疗的 0-III 期乳腺癌患者，并接受辅助激素治疗和放疗（n=1851）或序贯治疗（n=18429）。采用 1:4 倾向评分匹配和重叠加权进行两项倾向评分分析，比较术后 1 年内放射性肺炎和肺炎住院情况，以及住院期间入住重症监护病房和死亡情况。我们还按激素药物（芳香化酶抑制剂和他莫昔芬）进行了分层分析。

结果

倾向评分匹配分析显示，同时治疗与序贯治疗发生放射性肺炎住院（0.27% vs. 0.58%，p=0.10）和肺炎住院（0.16% vs. 0.58%，p=0.05）的发生率无显著差异。重叠倾向评分加权分析也无显著差异（0.25% vs. 0.56%，p=0.08 和 0.15% vs. 0.44%，p=0.06）。两种治疗方案入住重症监护病房和院内死亡率无显著差异。分层分析结果相似。