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术后辅助放疗已经成为乳腺癌患者的治疗标准方案，但是既往前瞻研究认为雌激素受体阳性早期乳腺癌老年患者乳房肿块切除术后应避免接受放疗。由于雌激素受体阴性乳腺癌患者复发风险更高，尤其内分泌治疗无效者，目前却仍不明确术后辅助放疗对雌激素受体阴性乳腺癌患者的临床作用。 2016年12月，美国《临床乳腺癌》正式发表纽约州立大学上州医科大学的研究报告，发现辅助放疗对年龄≥70岁的雌激素受体阴性乳腺癌患者有益。 该研究查询了监测、流行病学和最终结果（SEER）数据库1998～2011年接受保乳手术、年龄≥70岁的T1期雌激素受体阴性浸润性导管癌患者，并分为2个队列：术后辅助放疗3685例、未术后辅助放疗1493例，对2个队列的患者和肿瘤特征、总生存和癌症相关生存进行卡方分析、不成对t检验、生存曲线（Kaplan-Meier）对数秩检验。 结果发现，术后辅助放疗患者较年轻（中位年龄：76岁比78岁，P＜0.0001）；术后辅助放疗患者与未术后辅助放疗相比，总生存和癌症相关生存显著改善，5年生存率分别为81.0%、61.7%（P＜0.0001），5年癌症相关生存率分别为93.1%、85.0%（P＜0.0001）。 因此，年龄≥70岁雌激素受体阴性早期乳腺癌患者乳房肿块切除术后，接受辅助放疗的总生存、乳腺癌相关生存明显优于未接受辅助放疗。该研究结果可为临床研究及治疗提供参考意见，提示临床医师在为此类患者选择治疗方案时，可以适当考虑给予术后辅助放疗，从而使此类患者最大程度获益。 Clin Breast Cancer. 2016 Dec;16(6):500-6. Adjuvant radiation improves survival in older women following breast-conserving surgery for estrogen receptor-negative breast cancer. Daugherty EC, Daugherty MR, Bogart JA, Shapiro A. SUNY Upstate Medical University, Syracuse, NY. PURPOSE: Published prospective trials have questioned the role of post-lumpectomy radiotherapy in older women with early-stage, estrogen receptor-positive (ER+) breast cancer. As the population with ER- tumors may be at greater risk for relapse, particularly given that endocrine therapy is not effective, we hypothesize the addition of radiation would be of benefit in patients age ≥ 70. METHODS AND MATERIALS: The Surveillance, Epidemiology, and End Results database was queried from 1998 to 2011 for patients age ≥ 70 years receiving breast-conserving surgery for T1, ER- invasive ductal carcinoma. Patients were separated into 2 cohorts: those treated with and without adjuvant radiotherapy. Chi-square analysis, unpaired t test and Kaplan-Meier log-rank were used to compare patient and tumor characteristics as well as overall and cancer-specific survival between the cohorts. RESULTS: Overall, 3685 patients received radiation and 1493 patients received lumpectomy alone. Patients treated with adjuvant radiation were younger (median age 76 vs. 78 years, P < .0001). Patients who received radiation had improved overall survival, with 5-year survival rates of 81.0% versus 61.7% without radiation (P < .0001). Cancer-specific survival was also improved with radiotherapy, with 5-year cancer-specific survival rates of 93.1% versus 85.0% (P < .0001). CONCLUSIONS: This analysis of the SEER database demonstrates that women ages 70 and older treated with lumpectomy and radiotherapy for ER-, early-stage breast cancer have improved overall survival and breast cancer-specific survival compared with patients treated with lumpectomy alone. This information may help in the decision-making process for this patient population. KEYWORDS: Breast conservation; ER-negative; Elderly; Radiotherapy; SEER PMID: 27431462 PII: S1526820916301720 DOI: 10.1016/j.clbc.2016.06.017 |
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