Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer
Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer
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DOI：
10.1001/jamasurg.2013.3049
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发表时间：
2014-03-01
期刊：
影响因子：
16.9
通讯作者：
Agarwal, Jayant
中科院分区：
文献类型：
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作者：
Agarwal, Shailesh;Pappas, Lisa;Agarwal, Jayant
据我们所知，最近没有研究直接比较乳房保护治疗（BCT）和乳房切除术后的生存率。目的比较当代队列患者中接受BCT、单独乳房切除术或乳房切除术加放疗的乳腺癌特异性生存率。设计、环境和参与者：我们进行单因素、多因素logistic回归和倾向分析，比较1998年至2008年期间接受BCT、单独乳房切除术或乳房切除术联合放疗的早期浸润性导管癌女性患者的死亡风险。数据来自监测、流行病学和最终结果数据库。早期乳腺癌被定义为肿瘤大小为4厘米或更小，阳性淋巴结不超过3个。乳房保护治疗，单独乳房切除术，或乳房切除术联合放疗。主要结局和测量：接受BCT、单独乳房切除术或乳房切除术合并放疗的患者的乳腺癌死亡风险。结果共纳入132149例患者。70%的患者采用保乳治疗，27%的患者采用单独乳房切除术，3%的患者采用乳房切除术联合放射治疗。接受BCT、单独乳房切除术或乳房切除术合并放疗的患者的5年乳腺癌特异性生存率分别为97%、94%和90% (P < 0.001)；10年乳腺癌特异性生存率分别为94%、90%和83% （P < 0.001）。多因素分析显示，行BCT的妇女生存率高于单纯行乳房切除术的妇女（风险比，1.31;P < .001）或行乳房放射切除术的妇女（风险比，1.47;P < .001）。当使用倾向评分分层时，治疗方法对生存率的影响相似。结论与意义：早期浸润性导管癌行BCT的患者比单纯行乳房切除术或乳房切除术联合放疗的患者具有更高的乳腺癌特异性生存率。有必要进行进一步的调查，以了解可能导致这种影响的原因。
IMPORTANCE To our knowledge, there are no recent studies that directly compare survival after breast conservation therapy (BCT) vs mastectomy.OBJECTIVE To compare the breast cancer-specific survival rates of patients undergoing BCT, mastectomy alone, or mastectomy with radiation using a contemporary cohort of patients.DESIGN, SETTING, AND PARTICIPANTS We performed univariate, multivariate logistic regression, and propensity analyses to compare the hazard of death for female patients with early-stage invasive ductal carcinoma treated with BCT, mastectomy alone, or mastectomy with radiation during the period from 1998 to 2008. The data were extracted from the Surveillance, Epidemiology, and End Results database. Early-stage breast cancer was defined as having a tumor size of 4 cm or smaller with 3 or less positive lymph nodes.EXPOSURE Breast conservation therapy, mastectomy alone, or mastectomy with radiation.MAIN OUTCOMES AND MEASURES Hazard of death due to breast cancer for patients undergoing BCT, mastectomy alone, or mastectomy with radiation.RESULTS A total of 132 149 patients were included in this analysis. Breast conservation therapy was used to treat 70% of patients, mastectomy alone was used to treat 27% of patients, and mastectomy with radiation was used to treat 3% of patients. The 5-year breast cancer-specific survival rates of patients who underwent BCT, a mastectomy alone, or a mastectomy with radiation were 97%, 94%, and 90%, respectively (P < .001); the 10-year breast cancer-specific survival rates were 94%, 90%, and 83%, respectively (P < .001). Multivariate analysis showed that women undergoing BCT had a higher survival rate than those undergoing mastectomy alone (hazard ratio, 1.31; P < .001) or mastectomy with radiation (hazard ratio, 1.47; P < .001). When propensity score stratification was used, the effect of treatment method on survival was similar.CONCLUSIONS AND RELEVANCE Patients who underwent BCT have a higher breast cancer-specific survival rate compared with those treated with mastectomy alone or mastectomy with radiation for early-stage invasive ductal carcinoma. Further investigation is warranted to understand what may be contributing to this effect.