Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
Curr Oncol. 2022 Aug 15;29(8):5731-5747. doi: 10.3390/curroncol29080452.
Background: This study aims to evaluate the overall and breast cancer-specific survival (BCSS) after breast-conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy plus RT in resectable breast cancer. Moreover, the aim is to also identify the subgroups who benefit from BCS plus RT and establish a predictive nomogram for stage II patients. Methods: Stage I−III breast cancer patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1990 and 2016. Patients with available clinical information were split into two groups: BCS plus RT and mastectomy plus RT. Kaplan−Meier survival analysis, univariate and multivariate regression analysis, and propensity score matching were used in the study. Hazard ratio (HR) was calculated based on stratified Cox univariate regression analyses. A prognostic nomogram by multivariable Cox regression model was developed for stage II patients, and consistency index (C-index) and calibration curve were used to evaluate the accuracy of the nomogram in the training and validation set. Results: A total of 24,590 eligible patients were enrolled. The difference in overall survival (OS) and BCSS remained significant in stage II patients both before and after PSM (after PSM: OS: HR = 0.8536, p = 0.0115; BCSS: HR = 0.7803, p = 0.0013). In stage II patients, the survival advantage effect of BCS plus RT on OS and BCSS was observed in the following subgroups: any age, smaller tumor size (<1 cm), stage IIA (T2N0, T0−1N1), ER (+), and any PR status. Secondly, the C-indexes for BCSS prediction was 0.714 (95% CI 0.694−0.734). The calibration curves showed perfect agreement in both the training and validation sets. Conclusions: BCS plus RT significantly improved the survival rates for patients of stage IIA (T2N0, T0−1N1), ER (+). For stage II patients, the nomogram was a good predictor of 5-, 10-, and 15-year BCSS. Our study may help guide treatment decisions and prolong the survival of stage II breast cancer patients.
本研究旨在评估保乳手术（BCS）加放疗（RT）与乳房切除术加 RT 治疗可切除乳腺癌的总生存（OS）和乳腺癌特异性生存（BCSS）。此外，还旨在确定从 BCS 加 RT 中获益的亚组，并为 II 期患者建立预测列线图。
从 1990 年至 2016 年，从监测、流行病学和最终结果（SEER）数据库中确定 I 期至 III 期乳腺癌患者。将具有可用临床信息的患者分为两组：BCS 加 RT 和乳房切除术加 RT。研究中使用 Kaplan-Meier 生存分析、单变量和多变量回归分析以及倾向评分匹配。基于分层 Cox 单变量回归分析计算风险比（HR）。为 II 期患者建立了多变量 Cox 回归模型的预后列线图，并使用一致性指数（C 指数）和校准曲线评估列线图在训练集和验证集中的准确性。
共纳入 24590 名合格患者。在未进行 PSM 之前和之后，II 期患者的 OS 和 BCSS 差异均有统计学意义（PSM 后：OS：HR=0.8536，p=0.0115；BCSS：HR=0.7803，p=0.0013）。在 II 期患者中，在以下亚组中观察到 BCS 加 RT 对 OS 和 BCSS 的生存优势效应：任何年龄、肿瘤较小（<1cm）、IIA 期（T2N0、T0-1N1）、ER（+）和任何 PR 状态。其次，BCSS 预测的 C 指数为 0.714（95%CI 0.694-0.734）。校准曲线在训练集和验证集均显示出完美的一致性。
BCS 加 RT 显著提高了 IIA 期（T2N0、T0-1N1）、ER（+）患者的生存率。对于 II 期患者，该列线图是预测 5 年、10 年和 15 年 BCSS 的良好预测因子。我们的研究可能有助于指导治疗决策并延长 II 期乳腺癌患者的生存时间。
