DBCG-IMN: A Population-Based Cohort Study on the Effect of Internal Mammary Node Irradiation in Early Node-Positive Breast Cancer
DBCG-IMN: A Population-Based Cohort Study on the Effect of Internal Mammary Node Irradiation in Early Node-Positive Breast Cancer
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DOI：
10.1200/jco.2015.63.6456
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发表时间：
2016-02-01
影响因子：
45.3
通讯作者：
Overgaard, Jens
中科院分区：
文献类型：
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作者：
Thorsen, Lise Bech Jellesmark;Offersen, Birgitte Vrou;Overgaard, Jens
目的目前尚不清楚内乳淋巴结照射是否能提高早期乳腺癌患者的生存率。一个可能的生存益处可能会被辐射引起的心脏病所抵消。我们评估了内乳淋巴结照射（IMNI）对早期淋巴结阳性乳腺癌患者的影响。患者和方法在这项全国范围内的前瞻性基于人群的队列研究中，我们纳入了接受单侧早期淋巴结手术的患者。阳性乳腺癌。右侧疾病患者被分配到IMNI，而左侧疾病患者被分配到没有IMNI，因为辐射诱发心脏病的风险。主要终点是总生存期。次要终点为乳腺癌死亡率和远处复发。分析是由意向treat.ResultsA共3,089例患者。其中，1，492名患者被分配到IMNI，而1，597名患者被分配到无IMNI。中位随访时间为8.9年，IMNI组8年总生存率为75.9%，而非IMNI组为72.2%。死亡的校正风险比（HR）为0.82（95% CI，0.72 - 0.94; P = 0.005）。IMNI组乳腺癌死亡率为20.9%，而非IMNI组为23.4%（校正HR为0.85; 95%CI为0.73 - 0.98; P = 0.03）。IMNI组8年时远处复发的风险为27.4%，而非IMNI组为29.7%（调整后HR为0.89; 95%CI为0.78 - 1.01; P = 0.07）。IMNI的效果在内乳淋巴结转移高危患者中更为明显。每组死于缺血性心脏病的人数相同。结论在这项自然分配、基于人群的队列研究中，IMNI提高了早期淋巴结阳性乳腺癌患者的总生存期。(C)2015年美国临床肿瘤学会
PurposeIt is unknown whether irradiation of the internal mammary lymph nodes improves survival in patients with early-stage breast cancer. A possible survival benefit might be offset by radiation-induced heart disease. We assessed the effect of internal mammary node irradiation (IMNI) in patients with early-stage node-positive breast cancer.Patients and MethodsIn this nationwide, prospective population-based cohort study, we included patients who underwent operation for unilateral early-stage node-positive breast cancer. Patients with right-sided disease were allocated to IMNI, whereas patients with left-sided disease were allocated to no IMNI because of the risk of radiation-induced heart disease. The primary end point was overall survival. Secondary end points were breast cancer mortality and distant recurrence. Analyses were by intention to treat.ResultsA total of 3,089 patients were included. Of these, 1,492 patients were allocated to IMNI, whereas 1,597 patients were allocated to no IMNI. With a median of 8.9 years of follow-up time, the 8-year overall survival rates were 75.9% with IMNI versus 72.2% without IMNI. The adjusted hazard ratio (HR) for death was 0.82 (95% CI, 0.72 to 0.94; P = .005). Breast cancer mortality was 20.9% with IMNI versus 23.4% without IMNI (adjusted HR, 0.85; 95% CI, 0.73 to 0.98; P = .03). The risk of distant recurrence at 8 years was 27.4% with IMNI versus 29.7% without IMNI (adjusted HR, 0.89; 95% CI, 0.78 to 1.01; P = .07). The effect of IMNI was more pronounced in patients at high risk of internal mammary node metastasis. Equal numbers in each group died of ischemic heart disease.ConclusionIn this naturally allocated, population-based cohort study, IMNI increased overall survival in patients with early-stage node-positive breast cancer. (C) 2015 by American Society of Clinical Oncology