Breast Cancer With Synchronous Metastases: Survival Impact of Exclusive Locoregional Radiotherapy
Breast Cancer With Synchronous Metastases: Survival Impact of Exclusive Locoregional Radiotherapy
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DOI：
10.1200/jco.2008.19.5396
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发表时间：
2009-03-20
影响因子：
45.3
通讯作者：
Labib, Alain
中科院分区：
文献类型：
--
作者：
Le Scodan, Romuald;Stevens, Denise;Labib, Alain
几项研究表明，手术切除原发肿瘤可提高诊断为IV期乳腺癌患者的生存率。在这种情况下，独家局部区域放射治疗（LRR）是局部区域治疗（LRT）的另一种形式。我们回顾性研究了LRT对乳腺癌同步转移患者生存的影响。患者和方法1980年至2004年间，我院收治的18753例乳腺癌患者中，598例（3.2%）在诊断时发生同步转移。前瞻性地记录了人口统计学数据、肿瘤特征、转移部位和治疗。LRT对总生存期（OS）的影响通过包括已知预后因素的多变量分析进行评估。结果581例患者中，320例接受了LRT （A组），261例未接受LRT （B组）。LRT包括249例患者（78%）的独家LRR， 41例患者（13%）的原发肿瘤手术加辅助LRR， 30例患者（9%）的单独手术。中位随访时间39个月，a组和B组3年OS率分别为43.4%和26.7% (P =。分别为00002)。在有内脏转移的女性患者中，LRT与生存率提高之间的关系尤为显著。在多因素分析中，LRT是一个独立的预后因素（风险比[HR] = 0.70; 95% CI, 0.58 ~ 0.85; P = 0.0002）。晚期死亡（>= 1年）的校正HR为0.76 （95% CI, 0.61 ~ 0.96; P = 0.02）。结论根据我们的经验，主要由独家LRR组成的LRT与乳腺癌同步转移患者的生存率提高有关。因此，排他性LRR可能是手术的积极替代方案。
PurposeSeveral studies suggest that surgical excision of the primary tumor improves survival among patients with stage IV breast cancer at diagnosis. Exclusive locoregional radiotherapy (LRR) is an alternative form of locoregional treatment (LRT) in this setting. We retrospectively studied the impact of LRT on the survival of breast cancer patients with synchronous metastases.Patients and MethodsAmong 18,753 breast cancer patients treated in our institution between 1980 and 2004, 598 patients (3.2%) had synchronous metastasis at diagnosis. Demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The impact of LRT on overall survival (OS) was evaluated by multivariate analysis including known prognostic factors.ResultsAmong 581 eligible patients, 320 received LRT (group A), and 261 received no LRT (group B). LRT consisted of exclusive LRR in 249 patients (78%), surgery of the primary tumor with adjuvant LRR in 41 patients (13%), and surgery alone in 30 patients (9%). With a median follow-up time of 39 months, the 3-year OS rates were 43.4% and 26.7% in group A and group B (P = . 00002), respectively. The association between LRT and improved survival was particularly marked in women with visceral metastases. LRT was an independent prognostic factor in multivariate analysis (hazard ratio [HR] = 0.70; 95% CI, 0.58 to 0.85; P = .0002). The adjusted HR for late death (>= 1 year) was 0.76 ( 95% CI, 0.61 to 0.96; P = .02).ConclusionIn our experience, LRT, consisting mainly of exclusive LRR, was associated with improved survival in breast cancer patients with synchronous metastases. Exclusive LRR may thus represent an active alternative to surgery.