Nierenberg Tori C, Crowell Kerri-Anne, Wang Ton, Rosenberger Laura H, DiLalla Gayle A, McDuff Susan G R, Kimmick Gretchen, Hwang E Shelley, Plichta Jennifer K
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Duke Cancer Institute, Durham, NC, USA.
Ann Surg Oncol. 2025 Jun 6. doi: 10.1245/s10434-025-17532-1.
We examined whether adjuvant radiation therapy (RT) monotherapy offers comparable overall survival (OS) to adjuvant endocrine therapy (ET) monotherapy following lumpectomy in women aged ≥ 65 years with favorable early stage breast cancer.
Patients aged ≥ 65 years, diagnosed with ER+/HER2-, cT1-2, N0 breast cancer, who underwent lumpectomy, were selected from the National Cancer Database (2004-2020). Kaplan-Meier estimates and Cox Proportional Hazards models evaluated OS differences across RT-only and ET-only groups.
The final cohort included 91,505 patients, with 11.8% receiving RT alone and 29.5% receiving ET only. Median follow-up was 67.6 months. ET-only patients were less likely to have a comorbidity score of 0 (ET 75.4% versus RT 80.8%; p < 0.001). Patients in the ET-only group had slightly larger tumors [ET 1.0 cm (0.7-1.5 cm) versus RT 0.9 cm (0.6-1.3 cm); p < 0.001] and were less likely to have grade 3 tumors (ET 7.0% versus RT 8.4%; p < 0.001). Unadjusted Kaplan-Meier analysis showed a higher 5 year OS for RT-only patients compared with ET-only (RT 88.9% versus ET 85.8%; p < 0.001). A similar trend was observed when stratified on the basis of age group (all log rank p < 0.05). In the adjusted multivariable analysis, RT-only remained associated with a slightly better OS than ET-only [ET ref, RT hazards ratio 0.91 (95% CI 0.85-0.97)].
For older patients with early stage, ER+/HER2- breast cancer who undergo lumpectomy, patients receiving RT-only had a small survival advantage over patients receiving ET-only, which may or may not be clinically relevant. Further comparisons of RT-only versus ET-only may be warranted in this unique population.
我们研究了在年龄≥65岁、早期乳腺癌预后良好的女性患者中，保乳术后辅助放疗（RT）单药治疗与辅助内分泌治疗（ET）单药治疗的总生存期（OS）是否相当。
从国家癌症数据库（2004 - 2020年）中选取年龄≥65岁、诊断为ER+/HER2-、cT1-2、N0乳腺癌且接受了保乳手术的患者。采用Kaplan-Meier估计法和Cox比例风险模型评估单纯放疗组和单纯内分泌治疗组之间的总生存期差异。
最终队列包括91,505例患者，其中11.8%仅接受放疗，29.5%仅接受内分泌治疗。中位随访时间为67.6个月。单纯内分泌治疗的患者合并症评分为0的可能性较小（内分泌治疗组为75.4%，放疗组为80.8%；p < 0.001）。单纯内分泌治疗组的患者肿瘤稍大[内分泌治疗组1.0 cm（0.7 - 1.5 cm），放疗组0.9 cm（0.6 - 1.3 cm）；p < 0.001]，且3级肿瘤的可能性较小（内分泌治疗组为7.0%，放疗组为8.4%；p < 0.001）。未经调整的Kaplan-Meier分析显示，单纯放疗患者的5年总生存期高于单纯内分泌治疗患者（放疗组为88.9%，内分泌治疗组为85.8%；p < 0.001）。按年龄组分层时也观察到类似趋势（所有对数秩检验p < 0.05）。在调整后的多变量分析中，单纯放疗与总生存期略优于单纯内分泌治疗仍相关[以内分泌治疗为参照，放疗的风险比为0.91（95%CI 0.85 - 0.97）]。
对于接受保乳手术的老年早期ER+/HER2-乳腺癌患者，单纯接受放疗的患者比单纯接受内分泌治疗的患者有微小生存优势，这在临床中可能相关也可能不相关。对于这一特殊人群，可能有必要进一步比较单纯放疗与单纯内分泌治疗。
