基于SEER数据库的不同分子分型局部晚期乳腺癌临床治疗决策对长期生存结局的影响

Effects of clinical treatment decisions on long-term survival outcomes of locally advanced breast cancer with different molecular subtypes based on the SEER database

目的探讨临床治疗决策对不同分子分型局部晚期乳腺癌(locally advanced breast cancer,LABC)长期生存的影响,促进临床医生制定针对LABC更加有效、个体化治疗方案的发展。方法通过SEER数据库检索2010~2015年病理学确诊为LABC的病例。通过绘制Kaplan-Meier曲线估计乳腺癌特异性生存期(Breast cancer specific survival,BCSS)和总生存期(overall survival,OS),在调整年龄、TNM分期、分级和治疗方式后,确定LABC的获益人群。结果总体保乳病人的5年OS与BCSS分别为77.43%、84.34%,全乳切除病人的5年OS与BCSS分别为68.03%、76.90%;Luminal A型LABC保乳病人的5年OS与BCSS分别为79.91%、87.23%,全乳切除病人的5年OS与BCSS分别为71.78%、81.16%;Luminal B型LABC保乳病人的5年OS与BCSS分别为79.30%、83.14%,全乳切除病人的5年OS与BCSS分别为70.37%、76.92%;三阴性LABC保乳病人的5年OS与BCSS分别为60.77%、68.13%,全乳切除病人的5年OS与BCSS分别为47.13%、55.94%;HER2阳性LABC保乳病人的5年OS与BCSS分别为75.42%、82.05%,全乳切除病人的5年OS与BCSS分别为67.05%、75.01%;三阳性LABC保乳病人的5年OS与BCSS分别为86.12%、91.63%,全乳切除病人的5年OS与BCSS分别为74.54%、82.56%。对于高分化、N0期、三阳性LABC化疗病人5年OS、BCSS分别为88.24%、76.91%,不化疗病人5年OS、BCSS分别为88.24%、90.91%(BCSS:P=0.812;OS:P=0.311)。结论LABC行保乳手术病人OS、BCSS均显著优于全乳切除,当对不同分子分型和分期LABC进行OS、BCSS比较时,保乳手术仍优于全乳切除。对于高分化、N0、三阳性LABC可以考虑豁免化疗。

Objective To explore the impact of clinical treatment decisions on the long-term survival of different molecular subtypes of locally advanced breast cancer(LABC),and to promote the development of more effective and individualized treatment regimens for LABC.Methods The cases of LABC diagnosed by pathology from 2010 to 2015 were searched in the database.Breast cancer-specific survival(BCSS)and overall survival(OS)were estimated by plotting Kaplan-Meier curves.The log rank test(Mantel-Cox)was used to analyze the difference between the groups,and the benefit population of LABC was determined after for age,TNM stage,grade,treatment methods.Results The 5-year OS and BCSS were 77.43%and 84.34%in breast-conserving,and 68.03%and 76.90%in mastectomy,respectively.The 5-year OS and BCSS of Luminal A LABC were 79.91%and 87.23%in breastconserving,and 71.78%and 81.16%in mastectomy,respectively.The 5-year OS and BCSS of Luminal B LABC were 79.30%and 83.14%in breast-conserving,and were 70.37%and 76.92%in mastectomy,respectively.The 5-year OS and BCSS of triple-negative LABC were 60.77%and 68.13%in breast-conserving,and those of mastectomy were 47.13%and 55.94%,respectively.The 5-year OS and BCSS of HER2 positive were 75.42%,82.05%in breastconserving,and were 67.05%and 75.01%in mastectomy,respectively;The 5-year OS and BCSS of triple-positive LABC were 86.12%and 91.63%in breast-conserving,and 74.54%and 82.56%in mastectomy,respectively.The 5-year OS and BCSS of well differentiated and N0 triple-positive LABC patients with chemotherapy were 88.24%and 76.91%,and those of patients without chmotherapy were 88.24%and 90.91%,respectively(BCSS:P=0.812;OS:P=0.311).Conclusion In the selective population,OS and BCSS of patients with LABC undergoing breast conserving surgery were significantly better than those of mastectomy.When OS and BCSS were compared for different molecular types and stages of LABC,breast-conserving surgery was still superior to total mastectomy.LABC could be considered for highly differentiated,N0 stage Triple positive without chemotherapy.