The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
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DOI：
10.1038/s41598-023-29888-z
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发表时间：
2023-02-18
影响因子：
4.6
通讯作者：
Huo, Dezheng
中科院分区：
文献类型：
--
作者：
Miyashita, Minoru;Balogun, Onyinye B.;Olopade, Olufunmilayo I.;Huo, Dezheng
IV期乳腺癌患者生存期的延长可能改变放疗局部控制乳腺癌原发灶的作用，但其生存效益尚不清楚。我们的目的是研究放疗对新发IV期乳腺癌患者的生存益处。2010 - 2015年，美国国家癌症数据库（National cancer DataBase）将接受乳房手术并在诊断后存活12个月（里程碑式分析）的IV期乳腺癌患者纳入研究。采用多变量Cox模型和倾向评分匹配来控制混杂效应。在11,850例患者中，3629例（30.6%）接受了术后乳房或胸壁放疗，8221例（69.4%）未接受放疗。在调整多个预后变量的多变量分析中，术后放疗与更好的生存率显著相关（风险比[HR] 0.74, 95%可信区间[95% ci] 0.69-0.80; P < 0.001）。放疗与骨转移（P < 0.001）或肺转移（P = 0.014）患者的生存率相关，但与肝转移（P = 0.549）或脑转移（P = 0.407）患者的生存率无关。放疗也与有一个（P < 0.001）或两个转移部位（P = 0.028）的患者的生存率相关，但与有三个或更多转移部位的患者无关（P = 0.916）。放疗对生存的影响在不同亚型之间没有差异。倾向评分匹配亚队列的生存分析结果与多变量分析结果完全一致。这些真实世界的数据表明，术后放疗可能提高新发IV期乳腺癌骨或肺转移的总生存率，无论其亚型如何。
Prolonged survival of patients with stage IV breast cancer could change the role of radiotherapy for local control of breast primary, but its survival benefit remains unclear. Our aim is to investigate the survival benefit of radiotherapy in de novo stage IV breast cancer. Stage IV breast cancer patients who received breast surgery and have survived 12 months after diagnosis (landmark analysis) were included in the study from 2010 to 2015 of the National Cancer DataBase. Multivariable Cox models and a propensity score matching were used to control for confounding effects. Of 11,850 patients, 3629 (30.6%) underwent postoperative radiotherapy to breast or chest wall and 8221 (69.4%) did not. In multivariable analysis adjusting for multiple prognostic variables, postoperative radiotherapy was significantly associated with better survival (hazard ratio [HR] 0.74, 95% confidence interval [95%CI] 0.69–0.80; P < 0.001). Radiotherapy was associated with improved survival in patients with bone (P < 0.001) or lung metastasis (P = 0.014), but not in patients with liver (P = 0.549) or brain metastasis (P = 0.407). Radiotherapy was also associated with improved survival in patients with one (P < 0.001) or two metastatic sites (P = 0.028), but not in patients with three or more metastatic sites (P = 0.916). The survival impact of radiotherapy did not differ among subtypes. The results of survival analysis in the propensity score-matched sub-cohort were precisely consistent with those of multivariable analysis. These real-world data show that postoperative radiotherapy might improve overall survival for de novo Stage IV breast cancer with bone or lung metastasis, regardless of subtypes.
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