Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China.
Department of General Surgery, Daqing Oilfield General Hospital, Daqing 163316, China.
Breast J. 2022 Aug 27;2022:5325556. doi: 10.1155/2022/5325556. eCollection 2022.
This study aims to analyze the survival outcomes of breast cancer (BC) patients, especially centrally located breast cancer (CLBC) patients undergoing breast-conserving therapy (BCT) or mastectomy.
Surveillance, epidemiology, and end results (SEER) data of patients with T1-T2 invasive ductal or lobular breast cancer receiving BCT or mastectomy were reviewed. We used X-tile software to convert continuous variables to categorical variables. Chi-square tests were utilized to compare baseline information. The multivariate logistic regression model was performed to evaluate the relationship between predictive variables and treatment choice. Survival outcomes were visualized by Kaplan-Meier curves and cumulative incidence function curves and compared using multivariate analyses, including the Cox proportional hazards model and competing risks model. Propensity score matching was performed to alleviate the effects of baseline differences on survival outcomes.
A total of 180,495 patients were enrolled in this study. The breast preservation rates fluctuated around 60% from 2000 to 2015. Clinical features including invasive ductal carcinoma (IDC), lower histologic grade, smaller tumor size, fewer lymph node metastases, positive ER and PR status, and chemotherapy use were independently correlated with BCT in both BC and CLBC cohorts. In all the classic Cox models and competing risks models, BCT was an independent favorable prognostic factor for BC, including CLBC patients in most subgroups. In addition, despite the low breast-conserving rate compared with tumors located in the other areas, CLBC did not impair the prognosis of BCT patients.
BCT is optional and preferable for most early-stage BC, including CLBC patients.
本研究旨在分析乳腺癌（BC）患者，尤其是中央区乳腺癌（CLBC）患者接受保乳治疗（BCT）或乳房切除术的生存结果。
回顾了接受 BCT 或乳房切除术的 T1-T2 浸润性导管或小叶乳腺癌患者的监测、流行病学和最终结果（SEER）数据。我们使用 X-tile 软件将连续变量转换为分类变量。使用卡方检验比较基线信息。使用多变量逻辑回归模型评估预测变量与治疗选择之间的关系。通过 Kaplan-Meier 曲线和累积发生率函数曲线可视化生存结果，并使用多变量分析（包括 Cox 比例风险模型和竞争风险模型）进行比较。进行倾向评分匹配以减轻基线差异对生存结果的影响。
本研究共纳入 180495 例患者。2000 年至 2015 年期间，保乳率波动在 60%左右。临床特征包括浸润性导管癌（IDC）、较低的组织学分级、较小的肿瘤大小、较少的淋巴结转移、雌激素受体和孕激素受体阳性状态以及化疗使用与 BC 和 CLBC 队列中的 BCT 独立相关。在所有经典的 Cox 模型和竞争风险模型中，BCT 是 BC 的独立有利预后因素，包括大多数亚组中的 CLBC 患者。此外，尽管与其他部位的肿瘤相比，CLBC 的保乳率较低，但并未损害 BCT 患者的预后。
BCT 是大多数早期 BC，包括 CLBC 患者的可选且优选的治疗方法。
