Department of Oncology, Baoji Gaoxin Hospital, No.19, Gaoxin 4 Road, Gaoxin District, Baoji, Shaanxi Province, 721000, China.
BMC Womens Health. 2024 Jun 5;24(1):324. doi: 10.1186/s12905-024-03165-1.
BACKGROUND: Whether patients with cTNM breast cancer can benefit from postoperative radiotherapy (RT) after receiving neoadjuvant chemotherapy (NAC) has been controversial. Therefore, the purpose of this study was to explore whether postoperative RT can benefit this group of patients in terms of survival. METHODS: We used Surveillance, Epidemiology, and End Results (SEER) data to conduct a retrospective review of women with cTNM breast cancer diagnosed between 20 and 80 years of age who received NAC between 2010 and 2015. Our study compared the impact of postoperative RT on overall survival (OS) and cancer-specific survival (CSS) in breast cancer patients using propensity score matching (PSM) and performed subgroup analysis. RESULTS: This study finally included 1092 cTNM breast cancer patients. Regardless of the patient's PSM status, postoperative RT was significantly associated with OS of cTNM breast cancer patients who received NAC. Specifically, the 10-year OS rate was 78.7% before PSM matching, compared with 71.1% in patients who did not receive postoperative RT, and the difference was more significant after PSM matching, which was 83.1% and 71.1% respectively. However, postoperative RT did not significantly benefit CSS in patients with cTNM breast cancer who received NAC. The 10-year CSS rate was 81.4% VS 76.2% (P = 0.085) before PSM matching and 85.8% VS 76.2%(P = 0.076) after matching. Due to the intersection of OS and CSS curves, this restricted mean survival time (RMST) method was chosen as a supplement. After 60 months, the OS difference in RMST between the postoperative RT group and the non-radiotherapy (noRT) group was 7.37 months (95%CI: 0.54-14.21; P = 0.034), and the CSS difference was 5.18 months (95%CI: -1.31-11.68; P = 0.118). Subgroup analysis found that in patients with right-sided breast cancer, postoperative RT improved the patient's OS (HR = 0.45, 95%CI: 0.21-0.95, P = 0.037) and CSS (HR = 0.42, 95%CI: 0.18-0.98, P = 0.045). CONCLUSIONS: Our results showed that additional postoperative RT improved the OS of cTNM breast cancer patients who received NAC, but failed to improve their CSS. It is worth noting that in the subgroup analysis of patients with right-sided breast cancer, we observed significant improvements in OS and CSS. And further prospective studies are still needed to verify the effect of postoperative RT in different subgroups.
背景：接受新辅助化疗（NAC）后的 cTNM 乳腺癌患者是否能从术后放疗（RT）中获益一直存在争议。因此，本研究的目的是探讨术后 RT 是否能改善这组患者的生存。
方法：我们使用监测、流行病学和最终结果（SEER）数据，对 20 至 80 岁接受 2010 年至 2015 年 NAC 的 cTNM 乳腺癌患者进行回顾性研究。我们使用倾向评分匹配（PSM）比较了术后 RT 对乳腺癌患者总生存（OS）和癌症特异性生存（CSS）的影响，并进行了亚组分析。
结果：本研究最终纳入 1092 例 cTNM 乳腺癌患者。无论患者 PSM 状态如何，术后 RT 均与接受 NAC 的 cTNM 乳腺癌患者的 OS 显著相关。具体而言，PSM 匹配前的 10 年 OS 率为 78.7%，而未接受术后 RT 的患者为 71.1%，PSM 匹配后差异更显著，分别为 83.1%和 71.1%。然而，术后 RT 并未显著改善接受 NAC 的 cTNM 乳腺癌患者的 CSS。PSM 匹配前的 10 年 CSS 率为 81.4%比 76.2%（P=0.085），匹配后为 85.8%比 76.2%（P=0.076）。由于 OS 和 CSS 曲线的交点，本研究选择限制平均生存时间（RMST）方法作为补充。在 60 个月时，术后 RT 组与非放疗（noRT）组的 OS 差异在 RMST 中为 7.37 个月（95%CI：0.54-14.21；P=0.034），CSS 差异为 5.18 个月（95%CI：-1.31-11.68；P=0.118）。亚组分析发现，右侧乳腺癌患者术后 RT 可改善患者的 OS（HR=0.45，95%CI：0.21-0.95，P=0.037）和 CSS（HR=0.42，95%CI：0.18-0.98，P=0.045）。
结论：我们的结果表明，额外的术后 RT 提高了接受 NAC 的 cTNM 乳腺癌患者的 OS，但未能提高 CSS。值得注意的是，在右侧乳腺癌患者的亚组分析中，我们观察到 OS 和 CSS 有显著改善。并且仍然需要进一步的前瞻性研究来验证术后 RT 在不同亚组中的效果。
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