保乳治疗与改良根治术相比，无论临床淋巴结阳性还是阴性的乳腺癌患者，均能改善生存而不增加局部区域复发的风险。

Breast-Conserving Therapy is Associated with Improved Survival Without an Increased Risk of Locoregional Recurrence Compared with Mastectomy in Both Clinically Node-Positive and Node-Negative Breast Cancer Patients.

机构信息

Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

BC Cancer, Vancouver, BC, Canada.

出版信息

Ann Surg Oncol. 2023 Oct;30(11):6413-6424. doi: 10.1245/s10434-023-13784-x. Epub 2023 Jun 26.

DOI:10.1245/s10434-023-13784-x

PMID:37358683

Abstract

INTRODUCTION

Randomized trials demonstrated equivalent survival between breast-conserving surgery combined with radiotherapy (BCT) and mastectomy alone. Contemporary retrospective studies using pathological stage have reported improved survival with BCT. However, pathological information is unknown before surgery. To mimic real-world surgical decision-making, this study assesses oncological outcomes by using clinical nodal status.

METHODS

Female patients aged 18-69 years who were treated with upfront BCT or mastectomy between 2006 and 2016 for T1-3N0-3 breast cancer were identified by using prospective, provincial database. The patients were divided into clinically node-positive (cN+) and node-negative (cN0) strata. Multivariable logistic regression was used to assess the effect of local treatment type on overall survival (OS), breast cancer-specific survival (BCSS), and locoregional recurrence (LRR).

RESULTS

Of 13,914 patients, 8228 had BCT and 5686 had mastectomy. Mastectomy patients had higher-risk clinicopathological factors: pathologically positive axillary staging was 21% in BCT and 38% in mastectomy groups. Most patients received adjuvant systemic therapy. For cN0 patients, 7743 had BCT and 4794 had mastectomy. On multivariable analysis, BCT was associated with improved OS (hazard ratio [HR] 1.37, p < 0.001) and BCSS (HR 1.32, p < 0.001), whereas LRR was not different between the groups (HR 0.84, p = 0.1). For cN+ patients, 485 had BCT and 892 had mastectomy. On multivariable analysis, BCT was associated with improved OS (HR 1.46, p = 0.002) and BCSS (HR 1.44, p = 0.008), whereas LRR was not different between the groups (HR 0.89, p = 0.7).

CONCLUSIONS

In the era of contemporary systemic therapy, BCT was associated with better survival than mastectomy, without an increased risk of locoregional recurrence for both cN0 and cN+ presentations.

摘要

简介

随机试验表明，保乳手术联合放疗（BCT）与单纯乳房切除术的生存结果相当。当代使用病理分期的回顾性研究报告称，BCT 可提高生存率。然而，手术前并不知道病理信息。为了模拟真实世界的手术决策，本研究通过临床淋巴结状态评估肿瘤学结果。

方法

通过前瞻性省级数据库，确定了 2006 年至 2016 年期间因 T1-3N0-3 期乳腺癌接受初始 BCT 或乳房切除术的 18-69 岁女性患者。将患者分为临床淋巴结阳性（cN+）和淋巴结阴性（cN0）两组。多变量逻辑回归用于评估局部治疗类型对总生存（OS）、乳腺癌特异性生存（BCSS）和局部区域复发（LRR）的影响。

结果

在 13914 名患者中，8228 名接受 BCT，5686 名接受乳房切除术。乳房切除术患者具有更高风险的临床病理因素：BCT 组病理腋窝分期阳性率为 21%，乳房切除术组为 38%。大多数患者接受了辅助全身治疗。在 cN0 患者中，7743 名接受 BCT，4794 名接受乳房切除术。多变量分析显示，BCT 与 OS（风险比 [HR] 1.37，p<0.001）和 BCSS（HR 1.32，p<0.001）的改善相关，而两组 LRR 无差异（HR 0.84，p=0.1）。在 cN+患者中，485 名接受 BCT，892 名接受乳房切除术。多变量分析显示，BCT 与 OS（HR 1.46，p=0.002）和 BCSS（HR 1.44，p=0.008）的改善相关，而两组 LRR 无差异（HR 0.89，p=0.7）。