Han Tingting, Shi Mingwei, Chen Qiwei, Chen Dongbo, Hao Jiqing
Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Oncology, Hefei BOE Hospital, Hefei, China.
Front Oncol. 2023 Oct 13;13:1012139. doi: 10.3389/fonc.2023.1012139. eCollection 2023.
The study aimed to explore the role of adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) in elder women with early-stage breast cancer (BC).
BC patients with 70-79 years of age, stage T1-2N0-1M0, undergoing BCS were screened in the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2015. The clinicopathological characteristics were balanced with propensity-score matching (PSM) method. Kaplan-Meier curves and Cox regression analyses were performed to determine the impact of adjuvant RT on BC patients.
Ultimately, 12,310 patients treated with adjuvant RT and 4837 patients treated with no RT, were involved in the analysis. Overall, patients treated with adjuvant RT was associated with a better breast cancer-specific survival (BCSS) (HR: 1.980 [1.596- 2.456], P < 0.001) and overall survival (OS) (HR: 2.214 [1.966- 2.494], P < 0.001) than those who did not undergo RT. After 1:1 PSM, adjuvant RT still performed advantage in both BCSS (HR: 1.918 [1.439- 2.557], P < 0.001) and OS (HR: 2.235 [1.904- 2.624], P < 0.001). In the multivariate COX analysis of BCSS, widowed, divorced and separated patients, tumor grade III, T2 stage, N1 stage, no RT, molecular subtypes with luminal B and triple negative were associated with a shorter BCSS (P < 0.05). In the multivariate COX analysis of OS, age ≥74 years, widowed, divorced and separated patients, tumor grade II/III, T2 stage, no RT, no chemotherapy, molecular subtypes with triple negative were associated with a shorter OS (P < 0.05). Furthermore, the advantages of adjuvant RT were observed in all subgroup analysis.
Adjuvant RT after BCS can improve both BCSS and OS in elderly patients with early-stage BC. Additionally, all subgroups analysis-derived BCSS and OS were in support of RT.
本研究旨在探讨保乳手术（BCS）后辅助放疗（RT）在老年早期乳腺癌（BC）女性中的作用。
在监测、流行病学和最终结果（SEER）数据库中筛选2010年至2015年间年龄在70 - 79岁、T1 - 2N0 - 1M0期且接受BCS的BC患者。采用倾向评分匹配（PSM）方法平衡临床病理特征。进行Kaplan - Meier曲线分析和Cox回归分析以确定辅助放疗对BC患者的影响。
最终，12310例接受辅助放疗的患者和4837例未接受放疗的患者纳入分析。总体而言，接受辅助放疗的患者与未接受放疗的患者相比，具有更好的乳腺癌特异性生存（BCSS）（风险比[HR]：1.980[1.596 - 2.456]，P < 0.001）和总生存（OS）（HR：2.214[1.966 - 2.494]，P < 0.001）。在1:1倾向评分匹配后，辅助放疗在BCSS（HR：1.918[1.439 - 2.557]，P < 0.001）和OS（HR：2.235[1.904 - 2.624]，P < 0.001）方面仍具有优势。在BCSS的多因素COX分析中，丧偶、离异和分居患者、肿瘤III级、T2期、N1期、未接受放疗、管腔B型和三阴性分子亚型与较短的BCSS相关（P < 0.05）。在OS的多因素COX分析中，年龄≥74岁、丧偶、离异和分居患者、肿瘤II/III级、T2期、未接受放疗、未接受化疗、三阴性分子亚型与较短的OS相关（P < 0.05）。此外，在所有亚组分析中均观察到辅助放疗的优势。
BCS后辅助放疗可改善老年早期BC患者的BCSS和OS。此外，所有亚组分析得出的BCSS和OS结果均支持放疗。
