Dai Luyao, Cui Hanxiao, Bao Yuanhang, Hu Liqun, Zhou Zhangjian, Lin Shuai, Zhang Xin, Wu Hao, Kang Huafeng, Ma Xiaobin
Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
School of Basic Medical Sciences, Xi'an Key Laboratory of Immune Related Diseases, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Front Oncol. 2022 Nov 2;12:1010088. doi: 10.3389/fonc.2022.1010088. eCollection 2022.
It is still unclear whether radiotherapy affects the long-term survival of breast cancer (BC) patients after immediate breast reconstruction (IBR). This study aims to evaluate the actual prognostic impact of radiotherapy on BC patients undergoing IBR, and to construct survival prediction models to predict the survival benefit of radiotherapy.
Data on eligible BC patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Competing risk models were used to assess breast cause-specific death (BCSD) and non-breast cancer cause-specific death (NBCSD). Kaplan-Meier curve, Cox risk regression model and forest map were used to evaluate and demonstrate overall survival (OS) and breast cancer-specific survival (BCSS). Survival prediction nomograms were used to predict OS and BCSS probabilities.
A total of 22,218 patients were selected, 24.9% received radiotherapy and 75.1% were without radiotherapy. Competing risk models showed that whether BCSD or NBCSD, the cumulative long-term risk of death in the radiotherapy group was higher than that in the non-radiotherapy group. The Kaplan-Meier curve showed that patients with different lymph node metastasis had different radiotherapy benefits. Multivariate stratified analysis showed that radiotherapy after autologous reconstruction was associated with poor BCSS in patients with stage N0, and radiotherapy after autologous reconstruction and combined reconstruction improved OS and BCSS in patients with stage N3. The C-indexes of nomogram (between 0.778 and 0.847) and calibration curves showed the good prediction ability of survival prediction model.
Radiotherapy can improve OS and BCSS in N3 stage BC patients undergoing immediate autologous reconstruction after mastectomy. The practical nomograms can be used to predict OS and BCSS of patients with or without radiotherapy, which is helpful for individualized treatment.
目前仍不清楚放疗对即刻乳房重建（IBR）术后乳腺癌（BC）患者的长期生存是否有影响。本研究旨在评估放疗对接受IBR的BC患者的实际预后影响，并构建生存预测模型以预测放疗的生存获益。
从监测、流行病学和最终结果（SEER）数据库中检索符合条件的BC患者数据。采用竞争风险模型评估乳腺癌特异性死亡（BCSD）和非乳腺癌特异性死亡（NBCSD）。使用Kaplan-Meier曲线、Cox风险回归模型和森林图评估并展示总生存（OS）和乳腺癌特异性生存（BCSS）。使用生存预测列线图预测OS和BCSS概率。
共纳入22218例患者，24.9%接受了放疗，75.1%未接受放疗。竞争风险模型显示，无论是BCSD还是NBCSD，放疗组的累积长期死亡风险均高于非放疗组。Kaplan-Meier曲线显示，不同淋巴结转移情况的患者放疗获益不同。多因素分层分析显示，自体重建后放疗与N0期患者较差的BCSS相关，自体重建及联合重建后放疗可改善N3期患者的OS和BCSS。列线图的C指数（介于0.778和0.847之间）及校准曲线显示生存预测模型具有良好的预测能力。
放疗可改善乳房切除术后接受即刻自体重建的N3期BC患者的OS和BCSS。实用的列线图可用于预测放疗或未放疗患者的OS和BCSS，有助于个体化治疗。
