Chevli Neil, Wang Kaidi, Haque Waqar, Schwartz Mary R, Nangia Julie, Sasaki Jennifer, Farach Andrew M, Hatch Sandra S, Butler E Brian, Teh Bin S
Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX.
Department of Radiation Oncology, University of Arkansas, Little Rock, AR.
Clin Breast Cancer. 2022 Oct;22(7):e807-e817. doi: 10.1016/j.clbc.2022.06.005. Epub 2022 Jul 7.
Pure Mucinous breast carcinoma (PMBC) is an invasive breast cancer with favorable prognosis. While pathology-specific guidelines exist for PMBC regarding adjuvant chemotherapy and endocrine therapy, no recommendations exist regarding locoregional treatment based on tumor histology. Prognostic impact of radiotherapy for patients with PMBC remains unclear.
The National Cancer Database was queried (2004-2017) for patients with pN0M0 PMBC who underwent lumpectomy. Chi-square testing compared categorical frequencies between patients who received radiotherapy versus those who did not. Propensity score matching created a 1:1 matched cohort of patients who received radiotherapy and patients who didn't. Kaplan-Meier analysis evaluated overall survival (OS). Cox proportional hazard analyses identified clinical and treatment factors prognostic for OS.
17,259 patients met selection criteria; 11,087 (74%) received radiotherapy while 3852 (26%) did not. After PSM, radiotherapy (HR 0.629; 95% CI 0.531-0.746), endocrine therapy (HR 0.676; 95% CI 0.567-0.805), black race (HR 0.703; 95% CI 0.498-0.991), and private insurance (HR 0.184; 95% CI 0.078-0.432) were favorable prognostic factors on multivariate Cox regression analysis while age ≥ 70 years (HR 2.668; 95% CI 1.903-3.740), tumor size > 20 mm (HR 1.964; 95% CI 1.613-2.391), and CDCC score > 0 (HR 1.770; 95% CI 1.474-2.126) were unfavorable prognostic factors. After PSM, 5-year OS was 86% for those who received radiotherapy and 81% for those who did not (P < .001).
This is the largest study to date on PMBC and the prognostic impact of adjuvant radiotherapy. Radiotherapy is associated with a survival advantage, suggesting omission of radiotherapy is not warranted.
纯黏液性乳腺癌（PMBC）是一种预后良好的浸润性乳腺癌。虽然存在关于PMBC辅助化疗和内分泌治疗的病理学特定指南，但对于基于肿瘤组织学的局部区域治疗尚无建议。放疗对PMBC患者的预后影响仍不清楚。
查询国家癌症数据库（2004 - 2017年）中接受保乳手术的pN0M0 PMBC患者。采用卡方检验比较接受放疗与未接受放疗患者的分类频率。倾向评分匹配创建了接受放疗和未接受放疗患者的1:1匹配队列。Kaplan-Meier分析评估总生存期（OS）。Cox比例风险分析确定OS的预后临床和治疗因素。
17259例患者符合入选标准；11087例（74%）接受了放疗，3852例（26%）未接受放疗。倾向评分匹配后，放疗（风险比[HR] 0.629；95%置信区间[CI] 0.531 - 0.746）、内分泌治疗（HR 0.676；95% CI 0.567 - 0.805）、黑人种族（HR 0.703；95% CI 0.498 - 0.991）和私人保险（HR 0.184；95% CI 0.078 - 0.432）在多因素Cox回归分析中是有利的预后因素，而年龄≥70岁（HR 2.668；95% CI 1.903 - 3.740）、肿瘤大小>20 mm（HR 1.964；95% CI 1.613 - 2.391）和CDCC评分>0（HR 1.770；95% CI 1.474 - 2.126）是不利的预后因素。倾向评分匹配后，接受放疗患者的5年总生存率为86%，未接受放疗患者为81%（P <.001）。
这是迄今为止关于PMBC及辅助放疗预后影响的最大规模研究。放疗与生存优势相关，提示不应省略放疗。
