Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status.
Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status.
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DOI：
10.1002/cncr.27795
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发表时间：
2013-04-01
期刊：
影响因子：
6.2
通讯作者：
Clarke, Christina A.
中科院分区：
文献类型：
--
作者：
Hwang, E. Shelley;Lichtensztajn, Daphne Y.;Gomez, Scarlett Lin;Fowble, Barbara;Clarke, Christina A.
随机临床试验（RCT）表明，早期乳腺癌保乳放疗（BCT）和乳房切除术的生存率相当。我们研究了一个大的、以人群为基础的接受BCT或M的妇女系列，以观察RCT的结果是否在一般人群中达到，以及在按年龄和激素受体（HR）状态分层时，手术类型是否存在生存差异。我们获得了1990年至2004年间在加利福尼亚州诊断为I期或II期乳腺癌的所有妇女的信息，这些妇女接受了BCT或乳房切除术治疗，并随访至2009年12月。我们使用Cox比例风险模型来比较BCT组和乳房切除术组的总生存期（OS）和疾病特异性生存期（DSS）。分析按年龄组（<50岁和≥50岁）和肿瘤激素受体（HR）状态进行分层。112,154名妇女符合资格标准。与乳房切除术的妇女相比，接受BCT的妇女的OS和DSS得到改善（整个队列OS的调整HR为0.81,95% CI为0.80 - 0.83）。年龄≥50岁伴有HR阳性疾病的女性（HR 0.86, 95% CI 0.82-0.91）相比于年龄<50岁伴有HR阴性疾病的女性（HR 0.88, 95% CI 0.79-0.98）， BCT与乳腺切除术相比的DSS获益更大；然而，在分析的所有亚组中都看到了这种趋势。在早期乳腺癌患者中，BCT与改善的DSS相关。这些数据提供了信心，无论年龄或HR状态如何，BCT仍然是早期疾病的有效替代乳房切除术。
Randomized clinical trials (RCT) have demonstrated equivalent survival for breast conserving therapy with radiation (BCT) and mastectomy for early stage breast cancer. We studied a large, population-based series of women who underwent BCT or M to observe whether outcomes of RCT were achieved in the general population, and whether survival differed by surgery type when stratified by age and hormone receptor (HR) status. We obtained information regarding all women diagnosed in the state of California with stage I or II breast cancer between 1990 and 2004, treated with either BCT or mastectomy and followed for vital status through December 2009. We used Cox proportional hazards modeling to compare overall survival (OS) and disease-specific survival (DSS) between BCT and mastectomy groups. Analyses were stratified by age group (<50 years and ≥50 years) and tumor hormone receptor (HR) status. 112,154 women fulfilled eligibility criteria. Women undergoing BCT had improved OS and DSS when compared to women with mastectomy (adjusted HR for OS entire cohort 0.81, 95% CI 0.80 – 0.83). The DSS benefit with BCT compared to mastectomy was greater among women age≥50 with HR-positive disease (HR 0.86, 95% CI 0.82–0.91) than among women age<50 with HR-negative disease (HR 0.88, 95% CI 0.79–0.98); however, this trend was seen among all subgroups analyzed. Among patients with early stage breast cancer, BCT was associated with improved DSS. These data provide confidence that BCT remains an effective alternative to mastectomy for early stage disease regardless of age or HR status.
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影响因子：
45.3
作者：
Freedman, Rachel A.;He, Yulei;Keating, Nancy L.
通讯作者：
Keating, Nancy L.
影响因子：
6.2
作者：
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van der Sangen, Maurice J. C.;van de Wiel, Fenneke M. M.;Voogd, Adri C.
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Voogd, Adri C.
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45.3
作者：
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通讯作者：
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120.7
作者：
Morrow, Monica;Jagsi, Reshma;Alderman, Amy K.;Griggs, Jennifer J.;Hawley, Sarah T.;Hamilton, Ann S.;Graff, John J.;Katz, Steven J.
通讯作者：
Katz, Steven J.