背景:基于癌细胞的分子表达,乳腺癌的分子亚型已被用于对患者进行分类,以预测临床结果和预后。然而,关于分子亚型对保乳手术(BCS)后放疗(RT)疗效的影响,还需要进一步的证据,特别是在基于人口的背景下。因此,本研究采用倾向评分匹配的队列设计,以研究分子亚型在BCSRT后患者结局分层中的潜在作用,并确定可能出现的具体临床获益.
方法:从2006年到2019年,本研究包括来自台湾国家健康保险研究数据库的59,502名接受BCS的乳腺癌患者。使用倾向评分来匹配患有和不患有RT的患者之间的混杂变量在每个亚型的乳腺癌中。即管腔A,管腔B/HER2阴性,管腔B/HER2阳性,基底样,和HER2富集的。评估了几种临床结果,就局部复发(LR)而言,区域复发(RR),远处转移(DM),无病生存率(DFS),总生存率(OS)。
结果:在BCS后RT之后,管腔A和管腔B/HER2阳性乳腺癌患者的LR降低(调整后的风险比[aHR]=0.18,p<0.0001;0.24,p=0.0049)。此外,在管腔A患者中观察到RR降低和DFS改善(aHR=0.15,p=0.0004;和0.29,p<0.0001),管腔B/HER2阴性(aHR=0.06,p=0.0093;和,0.46,p=0.028),和管腔B/HER2阳性(aHR=0.14,p=0.01;并且,0.38,p<0.0001)乳腺癌。值得注意的是,在腔A患者中发现OS益处(aHR=0.62,p=0.002),管腔B/HER2阴性(aHR=0.30,p<0.0001),基底样(AHR=0.40,p<0.0001),和HER2富集(AHR=0.50,p=0.03),但不是管腔B/HER2阳性疾病。值得注意的是,当考虑DM时,接受RT的管腔A患者的DM累积发生率低于未接受RT的患者(p=0.02).
结论:在接受BCS的管腔A乳腺癌患者中,RT可以降低肿瘤转移的可能性。RT之后,肿瘤的激素受体状态可以预测LR的肿瘤控制,RR,和DFS。此外,管腔乳腺癌患者的HER2状态可能是BCSRT后OS的额外预测因子.然而,需要进一步的前瞻性研究来验证这些发现.
Based on the molecular expression of cancer cells, molecular subtypes of breast cancer have been applied to classify patients for predicting clinical outcomes and prognosis. However, further evidence is needed regarding the influence of molecular subtypes on the efficacy of radiotherapy (RT) after breast-conserving surgery (BCS), particularly in a population-based context. Hence, the present
study employed a propensity-score-matched cohort design to investigate the potential role of molecular subtypes in stratifying patient outcomes for post-BCS RT and to identify the specific clinical benefits that may emerge.
From 2006 to 2019, the present
study included 59,502 breast cancer patients who underwent BCS from the Taiwan National Health Insurance Research Database. Propensity scores were utilized to match confounding variables between patients with and without RT within each subtype of breast cancer, namely luminal A, luminal B/HER2-negative, luminal B/HER2-positive, basal-like, and HER2-enriched ones. Several clinical outcomes were assessed, in terms of local recurrence (LR), regional recurrence (RR), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS).
After post-BCS RT, patients with luminal A and luminal B/HER2-positive breast cancers exhibited a decrease in LR (adjusted hazard ratio [aHR] = 0.18, p < 0.0001; and, 0.24, p = 0.0049, respectively). Furthermore, reduced RR and improved DFS were observed in patients with luminal A (aHR = 0.15, p = 0.0004; and 0.29, p < 0.0001), luminal B/HER2-negative (aHR = 0.06, p = 0.0093; and, 0.46, p = 0.028), and luminal B/HER2-positive (aHR = 0.14, p = 0.01; and, 0.38, p < 0.0001) breast cancers. Notably, OS benefits were found in patients with luminal A (aHR = 0.62, p = 0.002), luminal B/HER2-negative (aHR = 0.30, p < 0.0001), basal-like (aHR = 0.40, p < 0.0001), and HER2-enriched (aHR = 0.50, p = 0.03), but not luminal B/HER2-positive diseases. Remarkably, when considering DM, luminal A patients who received RT demonstrated a lower cumulative incidence of DM than those without RT (p = 0.02).
In patients with luminal A breast cancer who undergo BCS, RT could decrease the likelihood of tumor metastasis. After RT, the tumor\'s hormone receptor status may predict tumor control regarding LR, RR, and DFS. Besides, the HER2 status of luminal breast cancer patients may serve as an additional predictor of OS after post-BCS RT. However, further prospective studies are required to validate these findings.