66310The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China.
These authors contributed equally to this work.
Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338221089937. doi: 10.1177/15330338221089937.
The role of postmastectomy radiotherapy (PMRT) in patients with de novo stage IV breast cancer is unclear. This study aimed to evaluate the value of PMRT for metastatic breast cancer who underwent a modified radical mastectomy. Data on de novo stage IV breast cancer patients who received modified radical mastectomy between 2010 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) analysis based on age, T stage, N stage, breast subtype, and chemotherapy was conducted to balance baseline clinical characteristics. The prognostic roles of PMRT on cancer-specific survival (CSS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox proportional hazard models. A total of 1944 patients were enrolled before PSM. After PSM, 1458 patients were included. PMRT improved the prognosis of CSS and OS. Multivariate Cox analysis showed that PMRT was independently prognostic for CSS (HR 0.739, 95% CI. 0.619-0.884, P = 0.001) and OS (HR 0.744, 95%CI 0.628-0.8810, P = 0.001). Further subgroup analyses found that survival superiority was observed in T3-4 or N + subgroup (both P < 0.001 for CSS and OS), and Her2-/HR + breast subtype (HR 0.703, 95%CI 0.558-0.888 for CSS, and HR 0.712, 95%CI 0.573-0.885 for OS), especially in patients with bone metastasis but without brain metastasis. PMRT improved survival in de novo stage IV breast cancer patients in selected T3-4 or N + subgroup and Her2-/HR + breast subtype. However, these findings need to be validated by further studies before being incorporated into clinical practice.
新诊断为 IV 期乳腺癌患者行术后放疗(PMRT)的作用尚不清楚。本研究旨在评估改良根治性乳房切除术治疗转移性乳腺癌的价值。
从监测、流行病学和最终结果(SEER)数据库中检索了 2010 年至 2015 年间接受改良根治性乳房切除术的新诊断为 IV 期乳腺癌患者的数据。基于年龄、T 分期、N 分期、乳房亚型和化疗进行倾向评分匹配(PSM)分析,以平衡基线临床特征。采用 Kaplan-Meier 法和 Cox 比例风险模型分析 PMRT 对癌症特异性生存(CSS)和总生存(OS)的预后作用。
在 PSM 之前,共纳入 1944 例患者。PSM 后,纳入 1458 例患者。PMRT 改善了 CSS 和 OS 的预后。多变量 Cox 分析显示,PMRT 对 CSS(HR 0.739,95%CI.0.619-0.884,P=0.001)和 OS(HR 0.744,95%CI 0.628-0.8810,P=0.001)有独立的预后作用。进一步的亚组分析发现,在 T3-4 或 N+亚组(CSS 和 OS 的 P 值均<0.001)和 Her2-/HR+乳房亚型(CSS 的 HR 0.703,95%CI 0.558-0.888,OS 的 HR 0.712,95%CI 0.573-0.885)中,生存优势更明显,尤其是在有骨转移而无脑转移的患者中。
PMRT 改善了选定的 T3-4 或 N+亚组和 Her2-/HR+乳房亚型的新诊断为 IV 期乳腺癌患者的生存。然而,这些发现需要进一步的研究来验证,然后才能纳入临床实践。
Nan Fang Yi Ke Da Xue Xue Bao. 2021-11-20
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