Yang Shi-Ping, Tan Lu-Lu, Zhou Ping, Lian Chen-Lu, Wu San-Gang, He Zhen-Yu
Department of Radiation Oncology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China.
Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Front Oncol. 2022 Nov 23;12:917054. doi: 10.3389/fonc.2022.917054. eCollection 2022.
To evaluate whether adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) was associated with better survival among elderly (≥70 years) breast cancer patients with T1-2N0 and estrogen receptor (ER) positive disease.
We included patients who met the inclusion criteria between 2010 and 2014 from the Surveillance, Epidemiology, and End Results program. Patients were subdivided into three groups based on surgery and RT: BCS alone, BCS plus RT, and refusal of RT. The primary outcomes were breast cancer-specific survival (BCSS) and overall survival (OS). Chi-squared tests, Kaplan-Meier method, and Multivariate Cox regression analysis were used for statistical analysis. Propensity score matching (PSM) was performed to minimize the potential selection bias.
A total of 26586 patients were included in this analysis. The median follow-up was 66 months. Of these patients, 15591 (58.6%) patients received RT, RT was recommended but not performed due to patient refusal for 1270 (4.8%) patients, and RT was not recommended for 9725 (36.6%) patients. The 5-year BCSS was 98.3% for patients receiving RT, 97.1% for patients refusal of RT, and 96.4% for patients not recommended RT (P<0.001). The 5-year OS was 88.6% for patients receiving RT, 77.6% for patients who refused RT, and 72.1% for patients not recommended RT (P<0.001). Multivariate Cox regression analyses showed that patients who received adjuvant RT after BCS had significantly better BCSS (hazard ratio [HR] 0.523, 95%confidence interval [CI] 0.447-0.612, P<0.001) and OS (HR 0.589, 95%CI 0.558-0.622, P<0.001) compared to those without RT. A total of 7721 pairs of patients were matched successfully between those with and without RT using PSM. The results also showed that patients who received RT after BCS had significantly better BCSS (HR 562, 95%CI 0.467-0.676, P<0.001) and OS (HR 0.612, 95%CI 0.0.575-0.652, P<0.001) compared to those without RT.
These data suggest that individual counseling is important for treatment decision-making in elderly breast cancer patients with T1-2N0 and ER-positive disease. Given the relatively lower toxicity of modern RT techniques, adjuvant RT should be recommended in patients with high life expectancy.
评估保乳手术（BCS）后辅助放疗（RT）是否与T1-2N0且雌激素受体（ER）阳性的老年（≥70岁）乳腺癌患者更好的生存率相关。
我们纳入了2010年至2014年期间来自监测、流行病学和最终结果计划中符合纳入标准的患者。患者根据手术和放疗情况分为三组：单纯BCS、BCS加RT以及拒绝放疗。主要结局为乳腺癌特异性生存（BCSS）和总生存（OS）。采用卡方检验、Kaplan-Meier法和多变量Cox回归分析进行统计分析。进行倾向评分匹配（PSM）以尽量减少潜在的选择偏倚。
本分析共纳入26586例患者。中位随访时间为66个月。在这些患者中，15591例（58.6%）接受了放疗，1270例（4.8%）患者因患者拒绝而推荐但未进行放疗，9725例（36.6%）患者未被推荐放疗。接受放疗患者的5年BCSS为98.3%，拒绝放疗患者为97.1%，未被推荐放疗患者为96.4%（P<0.001）。接受放疗患者的5年OS为88.6%，拒绝放疗患者为77.6%，未被推荐放疗患者为72.1%（P<0.001）。多变量Cox回归分析显示，BCS后接受辅助放疗的患者与未接受放疗的患者相比，BCSS显著更好（风险比[HR]0.523，95%置信区间[CI]0.447-0.612，P<0.001），OS也显著更好（HR 0.589，95%CI 0.558-0.622，P<0.001）。使用PSM在接受和未接受放疗的患者之间成功匹配了7721对患者。结果还显示，BCS后接受放疗的患者与未接受放疗的患者相比，BCSS显著更好（HR 0.562，95%CI 0.467-0.676，P<0.001），OS也显著更好（HR 0.612，95%CI 0.575-0.652，P<0.001）。
这些数据表明，对于T1-2N0且ER阳性的老年乳腺癌患者，个体化咨询对于治疗决策很重要。鉴于现代放疗技术毒性相对较低，对于预期寿命较高的患者应推荐辅助放疗。
