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目前，对于早期乳腺癌的手术推荐意见，主要根据2002年10月17日《新英格兰医学杂志》公布的NSABP B-06随机对照研究20年随访结果，该研究于1976年8月8日～1984年1月27日入组早期乳腺癌女性2163例，最终证实乳房切除手术与保乳治疗（保乳手术＋放疗）的生存结局相似。不过，近20年来，乳腺癌的早期筛查和非手术治疗方法突飞猛进，是否对两种手术方法的生存结局产生影响？ 2020年7月13日，美国乳腺外科医师学会和美国肿瘤外科学会《肿瘤外科学报》在线发表密歇根州立大学、密歇根州西部医疗集团的大数据分析报告，利用全国癌症数据库近10年来的早期乳腺癌患者数据，经过倾向评分匹配，对10万1118例保乳治疗（保乳手术＋放疗）与10万1188例乳房切除手术的5年总生存结局进行了比较。 作者对全国癌症数据库进行查询，获取2004～2015年诊断为I～II期乳腺癌女性患者手术数据43万1899例，其中乳房保留手术30万2299例、乳房切除手术12万9600例。保乳治疗定义为乳房肿块切除术＋放疗。由于两种手术患者的数量和特征相差悬殊，故根据种族、年龄、合并症评分、肿瘤部位、左侧右侧、单侧双侧、组织学类型、分级、大小、淋巴结、淋巴血管浸润、受体状态、化疗和内分泌治疗等特征，按1∶1的比例通过最近相邻法对两种手术患者进行倾向评分匹配。主要结局衡量指标为总生存。 结果，经过排除和匹配，保乳治疗与乳房切除的患者各10万1118例，全部目标变量相近。中位随访42个月。大多数为组织学类型为导管浸润癌（77%）和淋巴结阴性（84%）。雌激素受体阳性、孕激素受体阳性、人类表皮生长因子受体HER2阳性分别占83%、73%、15%。化疗占38%，内分泌治疗占71%。 保乳治疗与乳房切除的患者相比，5年总生存比例显著较高（92.9%比89.7%，P<0.001）。根据亚组分析，保乳治疗对于I期（P<0.001）和II期（P<0.001）乳腺癌都具有生存优势。 因此，该研究结果表明，通过对现代数据进行匹配，保乳治疗与乳房切除相比，早期乳腺癌患者的总生存比例显著提高。 Ann Surg Oncol. 2020 Jul 13. Online ahead of print. Breast-Conserving Therapy is Associated with Improved Survival Compared with Mastectomy for Early-Stage Breast Cancer: A Propensity Score Matched Comparison Using the National Cancer Database. Wrubel E, Natwick R, Wright GP. Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Spectrum Health Medical Group, Grand Rapids, MI, USA. INTRODUCTION: Current recommendations for early-stage breast cancer are largely based on the NSABP B-06 trial demonstrating equivalent survival between mastectomy and lumpectomy. We sought to compare breast-conserving therapy (BCT) with mastectomy for treatment of early-stage breast cancer in a contemporary patient population. METHODS: A query of the NCDB PUF identified female breast cancer patients diagnosed from 2004 to 2015. Patients with stage I or II disease were included. BCT was defined as the receipt of lumpectomy plus radiation. Propensity scores were tabulated using race, age, Charlson/Deyo score, tumor site, laterality, histology, grade, size, number of nodes positive, lymph-vascular invasion, receptor status, receipt of chemotherapy, and endocrine therapy. Patients who received BCT versus mastectomy were matched using a 1:1 nearest neighbor technique. The primary outcome measured was overall survival. RESULTS: After exclusions and matching, two equal groups of 101,118 patients remained. Median follow-up was 42 months. The majority had invasive ductal histology (77%), and node-negative disease (84%). Receptor status included ER-positive (83%), PR-positive (73%), and HER2/Neu-positive (15%). Chemotherapy was received in 38% and endocrine therapy in 71%. Propensity score matching yielded equivalent groups across all target variables. The 5-year overall survival was superior for BCT compared with mastectomy (92.9% vs. 89.7%, p<0.001; Fig. 1). This survival advantage persisted for both stage I (p<0.001) and stage II (p<0.001) disease on subgroup analysis. CONCLUSIONS: BCT is associated with superior overall survival compared with mastectomy for early-stage breast cancer using well-matched, contemporary data. PMID: 32661849 DOI: 10.1245/s10434-020-08829-4 |
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