南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (11): 1733-1740.doi: 10.12122/j.issn.1673-4254.2021.11.20

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全乳切除术后放疗对化生性乳腺癌患者的生存影响

蔡文娟，庄 严，陈建辉，王宏梅   

  1. 南方医科大学南方医院放疗科，广东 广州 510515；南方医科大学公共卫生学院生物统计学系，广东省热带病研究重点实验室，广东 广州 510515
  • 出版日期:2021-11-20 发布日期:2021-12-10

Effect of postmastectomy radiotherapy on survival outcomes of patients with metaplastic breast cancer

CAI Wenjuan, ZHUANG Yan, CHEN Jianhui, WANG Hongmei   

  1. Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Biostatistics, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
  • Online:2021-11-20 Published:2021-12-10

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摘要： 目的 通过对比化生性乳腺癌（MpBC）与浸润性导管癌（IDC）的预后因素，明确全乳切除术后放疗（PMRT）对MpBC患者的总生存（OS）及乳腺癌特异性生存（BCSS）影响。方法 从SEER数据库筛选1998~2016年符合病理诊断、≥18岁并行乳腺癌根治术的女性MpBC和IDC 患者，且无远处转移及第二原发癌, 共纳入31 982例患者。研究终点是OS和BCSS，亚组包括MpBC/PMRT组（308例）、MpBC/No PMRT组（629例）和IDC/PMRT组（31 045例）。比较组间基线特征，并通过Kaplan-Meier生存分析和Cox回归模型分析比较MpBC的预后影响因素及各亚组的OS和BCSS。结果 在所有MpBC患者中，年龄≥50岁（81.2%）、病理分级Ⅲ级（68.0%）、ER阴性（75.9%）、PR阴性（79.8%）、T2~3（71.3%）、N0~1（85.6%）患者占比大。年龄、肿瘤T分期、N分期、PMRT、是否化疗与MpBC的OS显著相关（P<0.05），而病理分级、ER、PR状态与MpBC的OS差异无统计学意义（P>0.05）。Kaplan-Meier生存分析显示，MpBC/PMRT组OS（HR 1.394，95%CI：1.125~1.727，P<0.05）、BCSS（HR 1.390，95% CI：1.074~1.800，P<0.05）优于MpBC/No PMRT组，而其OS（HR 1.626，95%CI：1.386~1.908，P<0.001）、BCSS（HR 1.710，95% CI：1.418~2.062，P<0.001）显著劣于IDC/PMRT组。结论 MpBC具有独特的临床病理特点，年龄、肿瘤T分期、N分期、放疗及化疗是其预后影响因素；PMRT可改善MpBC患者的OS及BCSS。

关键词: 化生性乳腺癌；术后放疗；总生存；乳腺癌特异性生存

Abstract: Objective To evaluate the effect of postmastectomy radiotherapy (PMRT) on the overall survival (OS) and breast cancer-specific survival (BCSS) of patients with metaplastic breast cancer (MpBC) in comparison with those of patients with invasive ductal breast carcinoma (IDC). Methods We selected the patients with pathologically confirmed MpBC and IDC who either received PMRT or not from the archived cases (from January, 1998 to December, 2016) in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. In total, 31 982 patients were selected, including 308 patients with MpBC and PMRT, 629 with MpBC and PMRT, and 31 045 with IDC and PMRT. All the included patients were above 18 years of age without distant metastases or a second primary cancer and underwent radical surgery. Baseline characteristics of the patients were compared among the 3 subgroups, and multivariate Cox regression and Kaplan-Meier analyses were performed for analyzing the prognostic factors of MpBC, OS, and BCSS. Results The majority (81.2%) of patients with MpBC were older than 50 years, had pathological grade III (68%), and were negative for ER (75.9%) and PR (79.8%) and in stage T2-3 (71.3%) and N0-1 (85.6%). Multivariate Cox regression analysis showed that age, T stage, N stage, PMRT, and chemotherapy were significantly associated with the prognosis of patients with MpBC (P<0.05), while pathological grade, ER status, or PR status did not significantly affect the prognosis (P>0.05). Kaplan-Meier analysis showed that the patients with MpBC and PMRT had better OS (HR=1.394, 95% CI: 1.125-1.727; P<0.05) and BCSS (HR=1.390, 95% CI: 1.074-1.800; P<0.05) than those with MpBC who did not receive PMRT; but after PMRT, the patients with MpBC had worse OS (HR=1.626, 95%CI: 1.386-1.908; P<0.001) and BCSS (HR=1.710, 95% CI: 1.418-2.062; P<0.001) as compared with those with IDC. Conclusion MpBC has unique clinicopathological features. In patients with MpBC, age, T stage, N stage, radiotherapy and chemotherapy are all the prognostic factors affecting the survival outcomes, and PMRT can improve the OS and BCSS of the patients.

Key words: metaplastic breast cancer; postmastectomy radiotherapy; overall survival; breast cancer-specific survival