Wang Xiaoyu, Zhao Xiaolin, Cheng Pian, Zou Xiaomeng, Zhang Weike, Liu Jie
Jinan Central Hospital, Shandong Second Medical University, Weifang, China.
Department of Oncology, Yantai Laiyang Central Hospital, Yantai, China.
Sci Prog. 2025 Apr-Jun;108(2):368504251344185. doi: 10.1177/00368504251344185. Epub 2025 May 21.
The necessity of postmastectomy radiotherapy (PMRT) for patients whose initially positive lymph nodes become node-negative (ypN0) after neoadjuvant therapy (NAT) is uncertain. This study analyzed data from the Surveillance, Epidemiology, and End Results database to evaluate PMRT's effect on these patients. Women with unilateral breast cancer who achieved ypN0 status post-NAT from 2010 to 2019 were categorized into PMRT and non-PMRT groups. Propensity score matching (PSM) minimized confounding factors. Statistical tests and multivariate analysis identified survival prognostic factors, while Kaplan-Meier curves and forest plots assessed survival outcomes. The study involved 699 cases, with 458 receiving PMRT and 241 not. After matching, 194 patient pairs were examined. Multivariate analysis revealed stage III disease (hazard ratio: 2.06; 95% CI: 1.12-3.79, = 0.02) and lack of PMRT (hazard ratio: 2.48; 95% CI: 1.31-4.62, = 0.01) as independent survival risk factors. PMRT significantly improved overall survival (hazard ratio: 0.43; 95% CI: 0.26-0.72, < 0.001), especially in patients with clinical node status cN+ (cN1, hazard ratio: 0.47; 95% CI: 0.25-0.88, = 0.016; cN2-3 hazard ratio: 0.35; 95% CI: 0.15-0.86, = 0.017, respectively), grade 3 tumors(hazard ratio: 0.47; 95% CI: 0.25-0.88, = 0.016), stage III disease (hazard ratio: 0.47; 95% CI: 0.26-0.83, = 0.007), and triplenegative breast cancer (hazard ratio: 0.15; 95% CI: 0.05-0.42, < 0.001). However, it did not significantly benefit those with grade 1-2 tumors, stage II disease, HER2-positive, or hormone receptor-positive/HER2-negative tumors. The study suggests PMRT may not be necessary for these groups, particularly for HR-positive/HER2-negative grade 1-2 with stage II disease, due to limited short-term benefits.
对于新辅助治疗（NAT）后初始淋巴结阳性变为淋巴结阴性（ypN0）的患者，乳房切除术后放疗（PMRT）的必要性尚不确定。本研究分析了监测、流行病学和最终结果数据库中的数据，以评估PMRT对这些患者的影响。2010年至2019年NAT后达到ypN0状态的单侧乳腺癌女性被分为PMRT组和非PMRT组。倾向评分匹配（PSM）将混杂因素降至最低。统计检验和多变量分析确定了生存预后因素，而Kaplan-Meier曲线和森林图评估了生存结果。该研究共纳入699例病例，其中458例接受了PMRT，241例未接受。匹配后，对194对患者进行了检查。多变量分析显示，Ⅲ期疾病（风险比：2.06；95%置信区间：1.12-3.79，P = 0.02）和未接受PMRT（风险比：2.48；95%置信区间：1.31-4.62，P = 0.01）是独立的生存风险因素。PMRT显著改善了总生存期（风险比：0.43；95%置信区间：0.26-0.72，P < 0.001），尤其是临床淋巴结状态为cN+的患者（cN1，风险比：0.47；95%置信区间：0.25-0.88，P = 0.016；cN2-3风险比：0.35；95%置信区间：0.15-0.86，P分别为0.017）、3级肿瘤（风险比：0.47；95%置信区间：0.25-0.88，P = 0.016）、Ⅲ期疾病（风险比：0.47；95%置信区间：0.26-0.83，P = 0.007）和三阴性乳腺癌（风险比：0.15；95%置信区间：0.05-0.42，P < 0.001）。然而，对于1-2级肿瘤、Ⅱ期疾病、HER2阳性或激素受体阳性/HER2阴性肿瘤的患者，PMRT并没有显著益处。该研究表明，由于短期益处有限，这些组可能不需要PMRT，特别是对于Ⅱ期疾病的HR阳性/HER2阴性1-2级患者。
