Wang Jun, Zhong Xiao-Rong, Luo Ting, Xiang Zhong-Zheng, Zeng Yuan-Yuan, Yang Tian, Zheng Hong, Liu Lei
Department of Head and Neck Oncology, Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Breast Disease Center, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
J Oncol. 2022 Oct 25;2022:7550323. doi: 10.1155/2022/7550323. eCollection 2022.
Patients diagnosed with pT1-2N1M0 breast cancer between 2008 and 2018 in West China Hospital, Sichuan University were included. Locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS) were defined as endpoints. The propensity score matching (PSM), receiver operating characteristic (ROC) curve, the Kaplan-Meier analysis, and the Cox multivariable model were used for data analysis.
We identified 1,615 patients with T1-2N1M0 breast cancer, and 44.9% ( = 744) of them were treated with PMRT. With a median follow-up of 76 months, 46 (2.8%) recurrences, 96 (5.9%) deaths, and 80 (5.0%) breast cancer-related deaths occurred. The 5-year LRFS, DMFS, DFS, BCSS, and OS were 98.6%, 95.3%, 93.7%, 96.5%, and 96.0%, respectively. PMRT could not improve 5-year LRFS, DMFS, DFS, BCSS, and OS compared with non-PMRT neither before nor after PSM in the era of contemporary systemic treatment. ROC curve showed that the 8th pathological prognostic staging had better discriminative ability compared with the 7th anatomical staging [the area under the curve (AUC) 0.653 vs. 0.546, < 0.001]. In the anatomical staging system, PMRT had comparable 5-year BCSS in comparison with non-PMRT both in stages IIA (97.4% vs. 96.8%, = 0.799) and IIB (95.3% vs. 97.0%, = 0.071). When stratified according to the pathological staging, PMRT was associated with better 5-year BCSS in stage IIB (97.1% vs. 90.7%, = 0.039), while not in stages IA, IB, IIA, and IIIA. Multivariate analysis demonstrated that PMRT was a significantly protective factor for BCSS in stage IIB (HR 0.331, 95% CI: 0.100-0.967, = 0.044).
The new staging could better select high-risk patients with T1-2N1 breast cancer for radiotherapy compared with the 7th staging, and PMRT might be exempted except the 8th staging of IIB in the era of contemporary systemic therapy in this disease.
纳入2008年至2018年在四川大学华西医院诊断为pT1 - 2N1M0乳腺癌的患者。局部区域无复发生存期（LRFS）、远处转移无复发生存期（DMFS）、无病生存期（DFS）、乳腺癌特异性生存期（BCSS）和总生存期（OS）被定义为观察终点。采用倾向评分匹配（PSM）、受试者工作特征（ROC）曲线、Kaplan - Meier分析和Cox多变量模型进行数据分析。
我们确定了1615例T1 - 2N1M0乳腺癌患者，其中44.9%（n = 744）接受了术后放疗（PMRT）。中位随访76个月，发生46例（2.8%）复发、96例（5.9%）死亡和80例（5.0%）乳腺癌相关死亡。5年LRFS、DMFS、DFS、BCSS和OS分别为98.6%、95.3%、93.7%、96.5%和96.0%。在当代全身治疗时代，无论PSM前后，与未接受PMRT相比，PMRT均不能改善5年LRFS、DMFS、DFS、BCSS和OS。ROC曲线显示，与第7版解剖学分期相比，第8版病理预后分期具有更好的鉴别能力[曲线下面积（AUC）分别为0.653和0.546，P < 0.001]。在解剖学分期系统中，在IIA期（97.4%对96.8%，P = 0.799）和IIB期（95.3%对97.0%，P = 0.071），PMRT与未接受PMRT相比，5年BCSS相当。根据病理分期分层时，PMRT与IIB期更好的5年BCSS相关（97.1%对90.7%，P = 0.039），而在IA期、IB期、IIA期和IIIA期则不然。多变量分析表明，PMRT是IIB期BCSS的显著保护因素（HR 0.331，95%CI：0.100 - 0.967，P = 0.044）。
与第7版分期相比，新分期能更好地选择T1 - 2N1乳腺癌高危患者进行放疗，在该疾病当代全身治疗时代，除IIB期第8版分期外，PMRT可能可省略。
