使用倾向评分匹配队列对乳腺癌保乳治疗与乳房切除加乳房重建的生存比较。

Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort.

作者信息

Li Hao, Tian Shen, Wu Juan, Li Shu, Xiao Jun, Chen Yu-Ling, Song Jing-Yu, Pan Qin, Liang Xin-Yu, She Rui-Ling, Ma Chen-Yu, Wu Kai-Nan, Kong Ling-Quan

机构信息

Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016, China.

Department of Nephrology, Zigong First People's Hospital, Zigong, 643000, China.

出版信息

Sci Rep. 2025 Aug 19;15(1):30310. doi: 10.1038/s41598-025-16215-x.

DOI:10.1038/s41598-025-16215-x

PMID:40830193

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12365314/

Abstract

Cohort studies have suggested that breast-conserving therapy (BCT) offers better survival outcomes compared to mastectomy in patients with early breast cancer (BC). However, survival comparisons between BCT and mastectomy with breast reconstruction (Mastectomy + BR) are lacking. To investigate this, we conducted a cohort study using data from the SEER database. Patients with first-diagnosed locoregional BC between 2010 and 2016 were included and categorized into BCT and Mastectomy + BR groups. Propensity score matching (PSM) was performed to reduce selection bias. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the groups. After PSM, 56,420 patients were matched (1:1) into the BCT and Mastectomy + BR groups. No significant differences in BCSS or OS were observed between the two matched groups overall. However, subgroup analyses based on tumor size and nodal status showed that, among patients with node-negative and tumors ≤ 5 cm, Mastectomy + BR was associated with decreased BCSS compared to BCT (HR 1.23, 95% CI 1.02-1.49, P = 0.03). Inferior BCSS for Mastectomy + BR was also observed in tumors located in the upper-outer quadrant (HR 1.54, 95% CI 1.07-2.20, P = 0.02), nipple & central area (HR 4.98, 95% CI 1.44-17.21, P = 0.01), and in triple-negative BC (HR 1.45, 95% CI 1.07-1.98, P = 0.02). Additionally, in triple-negative BC, Mastectomy + BR was associated with worse OS (HR 1.33, 95% CI 1.00-1.76, P = 0.048). For patients with node-positive or tumors > 5 cm, no significant differences in BCSS or OS were found between the BCT and Mastectomy + BR groups, except in the HER2-enriched subtype, where Mastectomy + BR was associated with improved BCSS (HR 0.43, 95% CI 0.22-0.85, P = 0.015) and a marginal better OS (HR 0.54, 95% CI 0.29-1.01, P = 0.055). This study suggests that, except for the HER2-enriched subtype, BCT remains an equivalent or, in specific clinical scenarios, a superior alternative to Mastectomy + BR for the treatment of breast cancer.

摘要

队列研究表明，对于早期乳腺癌（BC）患者，保乳治疗（BCT）与乳房切除术相比能提供更好的生存结果。然而，缺乏BCT与乳房切除术后乳房重建（乳房切除术+乳房重建，Mastectomy + BR）之间的生存比较。为了对此进行研究，我们使用监测、流行病学和最终结果（SEER）数据库的数据进行了一项队列研究。纳入2010年至2016年首次诊断为局部区域性BC的患者，并将其分为BCT组和乳房切除术+乳房重建组。进行倾向评分匹配（PSM）以减少选择偏倚。比较两组之间的乳腺癌特异性生存（BCSS）和总生存（OS）。PSM后，56420例患者（1:1）被匹配到BCT组和乳房切除术+乳房重建组。总体而言，两个匹配组之间在BCSS或OS方面未观察到显著差异。然而，基于肿瘤大小和淋巴结状态的亚组分析表明，在淋巴结阴性且肿瘤≤5 cm的患者中，与BCT相比，乳房切除术+乳房重建与BCSS降低相关（风险比[HR] 1.23，95%置信区间[CI] 1.02 - 1.49，P = 0.03）。在位于外上象限的肿瘤（HR 1.54，95% CI 1.07 - 2.20，P = 0.02）、乳头及中央区域（HR 4.98，95% CI 1.44 - 17.21，P = 0.01）以及三阴性乳腺癌（HR 1.45，95% CI 1.07 - 1.98，P = 0.02）中，也观察到乳房切除术+乳房重建的BCSS较差。此外，在三阴性乳腺癌中，乳房切除术+乳房重建与较差的OS相关（HR 1.33，95% CI 1.00 - 1.76，P = 0.048）。对于淋巴结阳性或肿瘤>5 cm的患者，BCT组和乳房切除术+乳房重建组之间在BCSS或OS方面未发现显著差异，但在HER2富集亚型中除外，其中乳房切除术+乳房重建与改善的BCSS相关（HR 0.43，95% CI 0.22 - 0.85，P = 0.015）以及略好的OS（HR 0.54，95% CI 0.29 - 1.01，P = 0.055）。这项研究表明，除了HER2富集亚型外，BCT仍然是治疗乳腺癌的等同于乳房切除术+乳房重建的方法，或者在特定临床情况下是更好的选择。