Survival Impact of Locoregional Treatment of the Primary Tumor in De Novo Metastatic Breast Cancers in a Large Multicentric Cohort Study: A Propensity Score-Matched Analysis
Survival Impact of Locoregional Treatment of the Primary Tumor in De Novo Metastatic Breast Cancers in a Large Multicentric Cohort Study: A Propensity Score-Matched Analysis
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DOI：
10.1245/s10434-018-6831-9
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发表时间：
2019-02-01
影响因子：
3.7
通讯作者：
Dalenc, Florence
中科院分区：
文献类型：
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作者：
Pons-Tostivint, Elvire;Kirova, Youlia;Dalenc, Florence
局部区域治疗（LRT）对原发性转移性乳腺癌（MBC）患者总生存期（OS）的改善仍存在争议。我们研究的目的是在一个大型的回顾性队列中评估LRT对原发性MBC患者OS的影响，关于免疫组化特征和转移性播散的模式，我们对诊断为恶性肿瘤的患者进行了一项多中心回顾性研究，novo MBC选自2008年至2014年法国流行病学战略和医学经济学MBC数据库（NCT 03275311）。总共有4276名女性被纳入研究。LRT包括放疗、手术或两者兼有，40%的患者使用LRT。与未接受LRT的患者相比，接受LRT的患者更年轻（p <0.0001），并且更可能只有一个转移部位（p <0.0001）或只有骨转移（p <0.0001）。基于1年时标志性多变量分析，LRT与显著更好的OS相关（风险比0.65，95%置信区间0.55 - 0.76，p <0.001）。在所有敏感性分析中观察到相似的结果，包括倾向评分匹配。在亚组分析中，LRT与激素受体阳性/人表皮生长因子受体2（HER2）阴性患者的OS更好相关（61.6 vs. 45.9个月，p <0.001）和HER2阳性肿瘤（77.2 vs. 52.6个月，p = 0.008），但在三阴性肿瘤中并非如此（19 vs. 18.6个月，p = 0.54），并且还与内脏转移患者死亡风险的降低相关LRT与初治MBC患者中显著更好的OS相关，包括诊断时内脏受累的患者;然而，LRT不影响三阴性MBC中的OS。
Improvement in overall survival (OS) by locoregional treatment (LRT) of the primary tumor in de novo metastatic breast cancer (MBC) patients remains controversial.The aim of our study was to evaluate the impact of LRT on OS in a large retrospective cohort of de novo MBC patients, with regard to immunohistochemical characteristics and pattern of metastatic dissemination.We conducted a multicentric retrospective study of patients diagnosed with de novo MBC selected from the French Epidemiological Strategy and Medical Economics MBC database (NCT03275311) between 2008 and 2014. Overall, 4276 women were included in the study. LRT comprised either radiotherapy, surgery, or both.LRT was used in 40% of patients. Compared with no LRT, patients who received LRT were younger (p < 0.0001) and were more likely to have only one metastatic site (p < 0.0001) or bone-only metastases (p < 0.0001). LRT was associated with a significantly better OS based on landmark multivariate analysis at 1-year (hazard ratio 0.65, 95% confidence interval 0.55-0.76, p < 0.001). Similar results were observed in all sensitivity analyses, including propensity score matching. In subgroup analysis, LRT was associated with better OS in patients with hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative (61.6 vs. 45.9 months, p < 0.001) and HER2-positive tumors (77.2 vs. 52.6 months, p = 0.008), but not in triple-negative tumors (19 vs. 18.6 months, p = 0.54), and was also associated with a reduction in the risk of death in visceral metastatic patients (p < 0.001).LRT was associated with a significantly better OS in de novo MBC patients, including patients with visceral involvement at diagnosis; however, LRT did not impact OS in triple-negative MBC.