保乳术和乳房全切术对T_(1-2)N_(0)M_(0)期乳腺癌预后的影响:基于SEER数据库

Survival outcomes after breast-conserving therapy compared with mastectomy for T_(1-2)N_(0)M_(0)breast cancer patients based on SEER database

目的探讨保乳术和乳房全切术对T_(1-2)N_(0)M_(0)期乳腺癌患者预后的影响,为临床决策提供参考。方法提取SEER数据库中2010—2015年符合纳入排除标准的乳腺癌患者临床资料,根据手术方式不同分为保乳组和全切组,利用倾向性评分匹配方法(PSM)控制混杂因素,使用单因素和多因素Cox比例风险回归模型分析乳腺癌特异性生存率和总生存率的影响因素,生存分析采用Kaplan-Meier法并进行log-rank检验。结果最终纳入6786例患者,对两组基线资料1∶1进行PSM后共得到1664对患者,多因素Cox回归分析显示年龄≥70岁[HR=2.475,95%CI(1.672,3.664),P<0.001]、组织学分级为Ⅲ/Ⅳ期[HR=2.198,95%CI(1.244,3.883),P=0.007]、手术方式为保乳术[HR=0.574,95%CI(0.397,0.829),P=0.003]是影响乳腺癌特异性生存率的独立因素,其中保乳术能改善患者的乳腺癌特异性生存率[HR=0.574,95%CI(0.397,0.829),P=0.003]和总生存率[HR=0.460,95%CI(0.375,0.564),P<0.001]。进一步的亚组分析显示,保乳术能改善年龄在44岁及以下[HR=0.138,95%CI(0.039,0.485),P=0.002]和分子分型为HR+/HER2-[HR=0.531,95%CI(0.333,0.846),P=0.008]患者的乳腺癌特异性生存率。结论对于T_(1-2)N_(0)M_(0)期乳腺癌患者,保乳术可作为年龄在44岁及以下和分子分型为HR+/HER2-的患者的另一选择。

Objective To investigate survival outcomes after breast-conserving therapy compared with mastectomy for T_(1-2)N_(0)M_(0)breast cancer patients,and to help clinical decision-making.Methods The clinical data of patients who met the inclusion and exclusion criteria from 2010 to 2015 were screened in the Surveillance,Epidemiology,and End Results(SEER)database and divided into breast-conserving group and mastectomy group according to the surgical method.Propensity score matching(PSM)was applied to avoid confounding factors.Univariate and multivariate Cox proportional hazard models were applied to estimate the factors associated with breast cancer-specific survival(BCSS)and overall survival(OS).The Kaplan-Meier curve analysis was performed for survival analyses,and differences were compared using the log-rank test.Results A total of 6,786 patients were enrolled and then 1,664 pairs of patients were finally obtained after 1:1 PSM for baseline data of the two groups.Multivariate Cox regression analysis showed that age≥70 years old[HR=2.475,95%CI(1.672,3.664),P<0.001],Ⅲ/Ⅳgrade Histological[HR=2.198,95%CI(1.244,3.883),P=0.007],breast conserving surgery[HR=0.574,95%CI(0.397,0.829),P=0.003]were independent factors that affect the patient’s BCSS.Breast conserving surgery could significantly improve the BCSS[HR=0.574,95%CI(0.397,0.829),P=0.003]and OS[HR=0.460,95%CI(0.375,0.564),P<0.001]of patients.Further subgroup analysis showed that breastconserving therapy significantly improved BCSS in patients with age≤44 years old[HR=0.138,95%CI(0.039,0.485),P=0.002]and with HR+/HER2-molecular subtype[HR=0.531,95%CI(0.333,0.846),P=0.008].Conclusion For patients with T_(1-2)N_(0)M_(0)breast cancer,breast-conserving therapy is another choice,especially for those with age≤44 years old with HR+/HER2-molecular subtype.