基于SEER数据库和倾向性评分匹配法分析腋窝手术方式对1~2枚淋巴结阳性的老年早期乳腺癌患者乳房全切术后生存的影响

Effect of Different Axillary Surgeries on Survival of Elderly Breast Cancer Patients with 1-2 Positive Nodes after Mastectomy:A Study Based on SEER Database and Propensity Score Matching Method

目的探讨不同腋窝处理手术方式对1~2枚淋巴结阳性且行乳房全切的老年早期乳腺癌患者乳腺癌特异生存(breast cancer-specific survival,BCSS)的影响。方法收集SEER数据库2010~2015年期间65岁及以上病理诊断为T1~2期、1~2枚淋巴结阳性乳腺癌的乳房全切患者,腋窝手术方式为前哨淋巴结活检(sentinel lymph node biopsy,SLNB)或腋窝清扫(axillary lymph node dissection,ALND),将SLNB和ALND组间分布有显著性差异的变量纳入倾向性评分匹配,采用单因素及多因素Cox比例风险回归分析BCSS的独立风险因素以及不同腋窝手术方式(SLNB和ALND)对乳腺癌及不同亚型患者BCSS的影响。结果共纳入4863例患者,中位随访时间42个月,乳腺癌特异性死亡351例。匹配前SLNB患者1708例,ALND的患者3155例,倾向性评分匹配共匹配到1579对患者。匹配前后的多因素Cox回归分析显示婚姻状态、组织学分级、分子分型、T分期、是否放化疗为BCSS的独立预后影响因素(均P<0.05),而不同腋窝手术方式患者的BCSS无显著性差异(P>0.05)。亚组分析显示ALND能提高未婚/离异/丧偶、三阴性(HR-/HER2-)和HER2过表达型(HR-/HER2+)乳腺癌患者的BCSS(均P<0.05)。结论ALND不能显著改善1~2枚淋巴结阳性且乳房全切的老年早期乳腺癌患者的BCSS,但能显著改善未婚/离异/丧偶、三阴性和HER2过表达型乳腺癌患者的BCSS,该研究有利于指导此类患者腋窝手术方式的选择。

Objective To explore the effects of different types of axillary surgery on the breast cancer specific survival(BCSS)of elderly breast cancer patients with 1-2 positive lymph nodes after mastectomy.Methods T1-2 breast cancer patients with 1-2 positive nodes undergoing mastectomy from 2010 to 2015 were extracted from SEER database and were divided into sentinel lymph node biopsy(SLNB)group and axillary lymph node dissection(ALND)group.Variables with significant differences in distribution between SLNB and ALND groups were included in propensity score matching.Univariate and multivariate Cox analysis were used to identify independent risk factors for BCSS.The effects of different axillary surgeries on different subgroup patients were also analyzed.Results Totally,4863 patients were included,with 1708 SLNBs and 3155 ALNDs.The median follow-up time was 42 months and the number of breast cancer-specific death was 351.In total,1579 pairs of patients were matched by using propensity score method.The multivariate Cox analysis before and after matching showed that marital status,histologic grading,molecular subtype,T-staging,radiation and chemotherapy history were independent prognostic factors of BCSS(all P<0.05)while the effect of different axillary surgeries on BCSS was not significantly different(P>0.05).Further subgroup analysis showed that as compared with SLNB,ALND could significantly improve the BCSS of breast cancer patients who were unmarried,triple-negative(HR-/HER2-)and HER2 overexpressed(HR-/HER2+).Conclusion ALND could not improve the BCSS of all breast cancer patients in this study while it could significantly improve the BCSS of patients who were unmarried,triple-negative(HR-/HER2-)and HER2 overexpressed(HR-/HER2+),which may be significant for clinical practice.