一项基于监测、流行病学和最终结果（SEER）数据库分析的回顾性比较队列研究，探讨保乳手术和乳房切除术对多灶多中心乳腺癌患者的预后价值。

A retrospective comparative cohort study of SEER database analysis of the prognostic value of breast-conserving surgery and mastectomy in patients with multifocal multicenter breast cancer.

作者信息

Yu Miao, Xia Li, Cao Bangrong, Wang Meihua, Liu Shuanghua, Liu Shiwei, Mou Exian, Li Hui, Wang Hao

机构信息

Department of Breast, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

出版信息

Gland Surg. 2023 Feb 28;12(2):165-182. doi: 10.21037/gs-22-682. Epub 2023 Feb 27.

DOI:10.21037/gs-22-682

PMID:36915807

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10005985/

Abstract

BACKGROUND

The prognosis of multifocal multicentric breast cancer (MIBC) was related to many factors, and there are different recommendations for surgical approaches. We compare the effects of breast-conserving surgery (BCS) and mastectomy on the survival of multifocal multicenter breast cancer female patients.

METHODS

A total of 38,164 female patients with pathologically confirmed multifocal multicenter invasive breast cancer from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database were extracted, and the effects of different factors on the survival of these patients were retrospectively analyzed. The patients were divided into a BCS group and a mastectomy group, and the differences of breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the 2 groups.

RESULTS

Of the 38,164 patients included in the analysis, 14,533 (38.08%) underwent BCS and 23,631 (61.92%) underwent mastectomy. Multivariate analysis showed that age, grading, staging, number of lesions, radiotherapy, and BCS would affect the independent factors of BCSS and OS in patients. The median follow-up time was 108 months [interquartile range (IQR): 64-162 months). Multifactorial Cox proportional model analysis of prognostic risk showed that BCS reduced BCSS in patients older than 70 years [hazard ratio (HR): 1.35; 95% confidence interval (CI): 1.2-1.53; P<0.001], stage I and II, positive hormone receptor (HR), all 2-3 lesions, no radiotherapy (HR: 1.46; 95% CI: 1.33-1.6; P<0.001) and no chemotherapy (HR: 1.42; 95% CI: 1.28-1.57; P<0.001); BCS also reduced OS in patients over 40 years of age, stages I, II, and IIIC, all molecular subtypes, all HR-positive or negative, 2-3 lesions, and no radiotherapy (HR: 1.38; 95% CI: 1.31-1.46; P<0.001) and no chemotherapy (HR: 1.36; 95% CI: 1.29-1.44; P<0.001) patients. Multivariate Cox regression showed that BCS is an adverse factor for BCSS [adjusted HR 1.2 (1.11-1.3), P<0.001] and OS [adjusted HR 1.24 (1.19-1.3), P<0.001].

CONCLUSIONS

In early, good prognosis, treatment-sensitive patients, there is no survival advantage for BCS and more BCSS and OS benefit for mastectomy patients.

摘要

背景

多灶多中心乳腺癌（MIBC）的预后与多种因素相关，对于手术方式也有不同的推荐。我们比较了保乳手术（BCS）和乳房切除术对多灶多中心乳腺癌女性患者生存的影响。

方法

从监测、流行病学和最终结果（SEER）数据库中提取了2000年至2018年期间38164例经病理证实的多灶多中心浸润性乳腺癌女性患者，回顾性分析不同因素对这些患者生存的影响。将患者分为BCS组和乳房切除术组，比较两组之间乳腺癌特异性生存（BCSS）和总生存（OS）的差异。

结果

纳入分析的38164例患者中，14533例（38.08%）接受了BCS，23631例（61.92%）接受了乳房切除术。多因素分析表明，年龄、分级、分期、病灶数量、放疗和BCS是影响患者BCSS和OS的独立因素。中位随访时间为108个月[四分位数间距（IQR）：64 - 162个月]。预后风险的多因素Cox比例模型分析显示，BCS降低了70岁以上患者的BCSS[风险比（HR）：1.35；95%置信区间（CI）：1.2 - 1.53；P < 0.001]、I期和II期、激素受体阳性（HR）、所有2 - 3个病灶、未接受放疗（HR：1.46；95% CI：1.33 - 1.6；P < 0.001）以及未接受化疗（HR：1.42；95% CI：1.28 - 1.57；P < 0.001）的患者；BCS还降低了40岁以上、I期、II期和IIIC期、所有分子亚型、所有HR阳性或阴性、2 - 3个病灶、未接受放疗（HR：1.38；95% CI：1.31 - 1.46；P < 0.001）以及未接受化疗（HR：1.36；95% CI：1.29 - 1.44；P < 0.001）患者的OS。多因素Cox回归显示，BCS是BCSS[调整后HR 1.2（1.11 - 1.3），P < 0.001]和OS[调整后HR 1.24（1.19 - 1.3），P < 0.001]的不利因素。