METHODS: The National Cancer Database was queried for male patients ≥ 65 years with pathologic T1-2N0 (≤ 3 cm) HR + breast cancer treated with breast-conserving surgery with negative margins from 2004 to 2019. Adjuvant treatment was classified as HT alone, RT alone, or HT + RT. Male patients were matched with female patients for OS comparison. Survival analysis was performed using Cox regression and Kaplan - Meier method. Inverse probability of treatment weighting (IPTW) was applied to adjust for confounding.
RESULTS: A total of 523 patients met the inclusion criteria, with 24.4% receiving HT, 16.3% receiving RT, and 59.2% receiving HT + RT. The median follow-up was 6.9 years (IQR: 5.0-9.4 years). IPTW-adjusted 5-yr OS rates in the HT, RT, and HT + RT cohorts were 84.0% (95% CI 77.1-91.5%), 81.1% (95% CI 71.1-92.5%), and 93.0% (95% CI 90.0-96.2%), respectively. On IPTW-adjusted MVA, relative to HT, receipt of HT + RT was associated with improvements in OS (HR: 0.641; p = 0.042). RT alone was not associated with improved OS (HR: 1.264; p = 0.420).
CONCLUSIONS: Among men ≥ 65 years old with T1-2N0 HR + breast cancer, RT alone did not confer an OS benefit over HT alone. Combination of RT + HT demonstrated significant improvements in OS. De-escalation of treatment through omission of either RT or HT at this point should be done with caution.
方法:在国家癌症数据库中查询了2004年至2019年间,病理T1-2N0(≤3cm)HR+乳腺癌患者≥65岁,接受保乳手术,切缘阴性。辅助治疗被归类为单用HT,单独RT,或HT+RT。男性患者与女性患者进行OS比较。使用Cox回归和Kaplan-Meier方法进行生存分析。应用治疗加权逆概率(IPTW)来调整混杂因素。
结果:总共523例患者符合纳入标准,24.4%的人接受HT,16.3%接受RT,59.2%接受HT+RT。中位随访时间为6.9年(IQR:5.0-9.4年)。HT中IPTW调整的5年OS率,RT,和HT+RT队列为84.0%(95%CI77.1-91.5%),81.1%(95%CI71.1-92.5%),和93.0%(95%CI90.0-96.2%),分别。在IPTW调整的MVA上,相对于HT,接受HT+RT与OS改善相关(HR:0.641;p=0.042)。单纯RT与OS改善无关(HR:1.264;p=0.420)。
结论:在≥65岁的T1-2N0HR+乳腺癌患者中,与单独的HT相比,单独的RT并不能提供OS益处。RT+HT的组合显示了OS的显著改善。此时,通过省略RT或HT来降低治疗水平应谨慎。