|
对于淋巴结转移≥4枚的早期乳腺癌，乳房切除术后放疗为必要的治疗方案之一。不过，对于淋巴结转移1～3枚的早期乳腺癌，由于临床病理特征不同患者的生存获益显著不同，故乳房切除术后放疗的意义无法一概而论。 2020年3月19日，欧洲乳腺癌专科医师学会《乳腺》在线发表复旦大学附属肿瘤医院魏金丽、江一舟、邵志敏等学者的研究报告，根据不同的分子亚型以及其他风险因素，对肿瘤大小≤5厘米、淋巴结转移1～3枚、尚未远处转移（T1-2N1M0）乳腺癌女性患者乳房切除术后放疗的意义进行了大数据分析。 该队列回顾研究通过美国癌症研究所NCI监测流行病学最终结果SEER数据库，对2010～2014年被诊断为T1-2N1M0期乳腺浸润癌并接受乳房切除术的1万6521例患者进行回顾分析。通过生存曲线法计算总生存，并且根据分子亚型以及其他风险因素，通过多因素比例风险回归模型确定乳房切除术后放疗对总生存的影响。通过倾向评分匹配，对可测量的混杂因素进行平衡。 结果，其中乳房切除术后放疗患者5775例（35.0%）。 分子亚型分布：
乳房切除术后放疗与未放疗的患者相比：
此外，对于年龄≥56岁、单身、白人、乳房未重建、未化疗、导管癌、II级肿瘤患者，乳房切除术后放疗与未放疗相比，死亡风险较低（P<0.05）。 根据倾向评分匹配，对于肿瘤大小≤2厘米伴淋巴结转移1枚的管腔A型乳腺癌患者，乳房切除术后放疗的生存获益持久。 因此，该研究结果表明，对于T1-2N1期管腔A型乳腺癌患者，乳房切除术后放疗可以带来总生存获益，故乳房切除术后放疗的选择应该根据分子亚型以及其他风险因素进行个体化。 Breast. 2020 Mar 19;51:40-49. [Epub ahead of print] The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype. Jinli Wei, Yizhou Jiang, Zhimin Shao. Fudan University Shanghai Cancer Center, Cancer Institute, Shanghai Medical College, Fudan University, China. HIGHLIGHTS
OBJECTIVE: To evaluate the significance of postmastectomy radiotherapy (PMRT) in female breast cancer patients with T1-2N1M0 disease according to molecular subtypes and other risk factors. METHOD: We conducted a retrospective cohort-based study utilizing the Surveillance, Epidemiology, and End Results database. Patients who were diagnosed with T1-2N1M0 invasive breast cancer and received mastectomy between 2010 and 2014 were enrolled in our study. Overall survival (OS) was calculated with Kaplan-Meier method, and multivariant Cox hazard model was conducted to identify the impact of PMRT according to molecular subtypes and other risk factors. Propensity score matching (PSM) was applied to balance measurable confounders. RESULTS: Of all the 16,521 enrolled patients, 5775 (35.0%) cases received PMRT. The distribution of molecular subtype is 71.4% for Luminal A, 13.2% for Luminal B, 5.1% for HER2 enriched, and 10.3% for TNBC. The OS was significantly better for patients in PMRT group than the Non-PMRT group (P < 0.0001). Stratified by molecular subtype, PMRT significantly prolonged survival in Luminal A patients (HR: 0.759, 95% CI: 0.651-0.884, P < 0.001), Yet it brought no significant survival advantage in Luminal B, TNBC or HER2 enriched subtype (P = 0.914, P = 0.124, P = 0.103, respectively). Also, PMRT bore prognostic significance among those patients who were older than 56 years old, single, white, exempt from reconstruction and chemotherapy, and were with ductal, Grade II tumor (all P < 0.05). After PSM, the survival benefit of PRMT sustained in Luminal A patients with T1 tumor concomitant with one positive lymph node. CONCLUSION: Our study demonstrates a beneficial impact for PMRT on overall survival among Luminal A subtype breast cancer patients with T1-2N1 disease. The selection of PMRT should be stratified by molecular subtype and other risk factors. KEYWORDS: Breast cancer subtype, Postmastectomy radiotherapy, Overall survival DOI: 10.1016/j.breast.2020.03.003
|
|
|
