背景:cT1-2N1M0乳腺癌患者在接受新辅助化疗(NAC)后是否能从术后放疗(RT)中获益一直存在争议。因此,这项研究的目的是探讨术后RT是否可以使该组患者的生存受益。
方法:我们使用了监测,流行病学,和最终结果(SEER)数据,对2010年至2015年期间接受NAC的20至80岁的cT1-2N1M0乳腺癌女性进行回顾性审查。我们的研究使用倾向评分匹配(PSM)比较了术后放疗对乳腺癌患者总生存期(OS)和癌症特异性生存期(CSS)的影响,并进行了亚组分析。
结果:本研究最终纳入1092cT1-2N1M0乳腺癌患者。不管病人的PSM状态如何,cT1-2N1M0乳腺癌患者接受NAC的术后RT与OS显著相关。具体来说,PSM匹配前的10年OS率为78.7%,与71.1%未接受术后放疗的患者相比,PSM匹配后差异更显著,分别为83.1%和71.1%。然而,在接受NAC的cT1-2N1M0乳腺癌患者中,术后RT对CSS无显著益处.PSM匹配前的10年CSS率为81.4%vs76.2%(P=0.085),匹配后为85.8%vs76.2%(P=0.076)。由于OS和CSS曲线的交点,选择这种限制性平均生存时间(RMST)方法作为补充.60个月后,术后放疗组和非放疗组RMST的OS差异为7.37个月(95CI:0.54-14.21;P=0.034),CSS差异为5.18个月(95CI:-1.31-11.68;P=0.118)。亚组分析发现,在右侧乳腺癌患者中,术后RT改善患者的OS(HR=0.45,95CI:0.21~0.95,P=0.037)和CSS(HR=0.42,95CI:0.18~0.98,P=0.045)。
结论:我们的结果表明,额外的术后RT改善了接受NAC的cT1-2N1M0乳腺癌患者的OS,但未能改进他们的CSS。值得注意的是,在右侧乳腺癌患者的亚组分析中,我们观察到OS和CSS的显着改进。术后放疗在不同亚组中的效果仍需进一步的前瞻性研究来验证。
BACKGROUND: Whether patients with cT1 - 2N1M0 breast cancer can benefit from postoperative radiotherapy (RT) after receiving neoadjuvant chemotherapy (NAC) has been controversial. Therefore, the purpose of this
study was to explore whether postoperative RT can benefit this group of patients in terms of survival.
METHODS: We used Surveillance, Epidemiology, and End Results (SEER) data to conduct a retrospective review of women with cT1 - 2N1M0 breast cancer diagnosed between 20 and 80 years of age who received NAC between 2010 and 2015. Our
study compared the impact of postoperative RT on overall survival (OS) and cancer-specific survival (CSS) in breast cancer patients using propensity score matching (PSM) and performed subgroup analysis.
RESULTS: This
study finally included 1092 cT1 - 2N1M0 breast cancer patients. Regardless of the patient\'s PSM status, postoperative RT was significantly associated with OS of cT1-2N1M0 breast cancer patients who received NAC. Specifically, the 10-year OS rate was 78.7% before PSM matching, compared with 71.1% in patients who did not receive postoperative RT, and the difference was more significant after PSM matching, which was 83.1% and 71.1% respectively. However, postoperative RT did not significantly benefit CSS in patients with cT1 - 2N1M0 breast cancer who received NAC. The 10-year CSS rate was 81.4% VS 76.2% (P = 0.085) before PSM matching and 85.8% VS 76.2%(P = 0.076) after matching. Due to the intersection of OS and CSS curves, this restricted mean survival time (RMST) method was chosen as a supplement. After 60 months, the OS difference in RMST between the postoperative RT group and the non-radiotherapy (noRT) group was 7.37 months (95%CI: 0.54-14.21; P = 0.034), and the CSS difference was 5.18 months (95%CI: -1.31-11.68; P = 0.118). Subgroup analysis found that in patients with right-sided breast cancer, postoperative RT improved the patient\'s OS (HR = 0.45, 95%CI: 0.21-0.95, P = 0.037) and CSS (HR = 0.42, 95%CI: 0.18-0.98, P = 0.045).
CONCLUSIONS: Our results showed that additional postoperative RT improved the OS of cT1 - 2N1M0 breast cancer patients who received NAC, but failed to improve their CSS. It is worth noting that in the subgroup analysis of patients with right-sided breast cancer, we observed significant improvements in OS and CSS. And further prospective studies are still needed to verify the effect of postoperative RT in different subgroups.