摘要
目的本研究旨在确定pT_(1-2)N_(1)M_(0)期乳腺癌患者改良根治术后乳腺癌特异性生存(BCSS)的预后危险因素,并讨论可能省略术后放疗的患者的选择,以期提供临床决策。方法对SEER数据库中2010~2017年诊断的11351例患者数据进行回顾性分析,运用倾向评分匹配法(PSM)将7928例匹配患者分为放疗组(n=3964)和未放疗组(n=3964),采用单因素成组X^(2)检验、t检验和多因素Cox回归分析确定总生存(OS)及BCSS的预后因素,并使用Kaplan-Meier进行亚组生存分析,log-rank检验进行组间比较。结果中位随访时间80个月,PSM后放疗对pT_(1-2)N_(1)M_(0)期乳腺癌总人群OS及BCSS均有显著获益,OS放疗组(86.6%)与未放疗组(82.8%)差异有统计学意义(P_(OS)<0.001);BCSS放疗组(91.3%)与未放疗组(89.5%)差异有统计学意义(P_(BCSS)=0.007);PSM后多因素分析显示年龄>62岁、Grade分级III级、腋窝淋巴结转移比例>7%、三阴型、肿瘤大小2.4~5 cm是BCSS的独立预后危险因素(P<0.05);亚组分析中,放疗改善了高风险组患者的BCSS,放疗组与未放疗组(89.5%vs.86.7%,P_(BCSS)=0.001);在中风险组中,放疗组与未放疗组差异无统计学意义(96.4%vs.96.0%,P_(BCSS)=0.764);在低风险组中,放疗组与未放疗组(94.6%vs.98.8%,P_(BCSS)=0.031),放疗增加了患者的特异性死亡率。结论pT_(1-2)N_(1)M_(0)期乳腺癌患者的放疗受益明显不同,因此对于该类人群的放疗应个体化建议。对于高风险组的患者应考虑采用放疗,对于中风险组的患者应谨慎建议,而对于低风险组的患者应不予使用。
Objective To determine prognostic risk factors for Breast cancer-specific survival(BCSS)in patients with stage pT_(1-2)N_(1)M_(0)Breast cancer after modified radical mastectomy and to discuss the selection of patients who may omit postoperative radiotherapy in order to provide clinical decision-making.Methods A retrospective analysis of data from SEER database on 11351 patients diagnosed between 2010 and 2017.Total 7928 matched patients were divided into radiotherapy group(n=3964)and non-radiotherapy group(n=3964)by Propensity score matching(PSM)method.Univariate group chi-square test,t-test and multivariate Cox regression analysis were used to determine prognostic factors of OS(Overall survival)and BCSS.Kaplan-Meier method was used for subgroup survival analysis,and log-rank test was used for comparison between groups.Results The median follow-up time was 80 months.The OS and BCSS of patients with stage pT_(1-2)N_(1)M_(0)breast cancer were significantly benefited by radiotherapy(86.6%)and non-radiotherapy(82.8%),P OS<0.001,radiotherapy group(91.3%)and non-radiotherapy group(89.5%),P_(BCSS)=0.007.Multivariate analysis after PSM showed that age>62 years,Grade III,and the proportion of axillary lymph node metastasis>7%,triple negative,tumor size 2.4~5 cm were independent prognostic risk factors for BCSS(P<0.05).In subgroup analysis,radiotherapy improved the BCSS of high-risk group(89.5%vs.86.7%,P_(BCSS)=0.001).In the moderate-risk group,radiotherapy group and non-radiotherapy group(96.4%vs.96.0%,P_(BCSS)=0.764),there was no significant difference.In the low-risk group,radiotherapy group and non-radiotherapy group(94.6%vs.98.8%,P_(BCSS)=0.031),radiotherapy increased the cause-specific mortality of low-risk patients.Conclusion Patients with stage pT_(1-2)N_(1)M_(0)breast cancer have significantly different benefits from radiotherapy,so recommendations for radiotherapy for this population should be individualized.Radiotherapy should be considered for patients in the high-risk group,cautiously recommended for patients
作者
胡美雪
陈进
权毅
Hu Meixue;Chen Jin;Quan Yi(Sichuan Provincial Center for Gynaecology and Breast Surgery,The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《四川医学》
CAS
2023年第3期248-256,共9页
Sichuan Medical Journal
