2018年9月12日，欣達維旗下《腫瘤學(xué)雜志》在線(xiàn)發(fā)表復旦大學(xué)附屬腫瘤醫院王曉芳、馬金利、梅欣、楊昭志、俞曉立、郭小毛、章真、邵志敏等學(xué)者的研究報告，探討了乳腺癌患者單純乳房切除術(shù)后孤立性局部區域復發(fā)補救放療和全身治療結局的相關(guān)因素，同時(shí)重點(diǎn)關(guān)注了生物學(xué)亞型的預后意義。
該研究共入組乳腺癌切除術(shù)后孤立性局部區域復發(fā)接受治療患者269例，通過(guò)生存曲線(xiàn)法計算局部區域控制、無(wú)遠處轉移生存、無(wú)病生存、總生存的累積發(fā)生率，并按不同的激素受體（HR）和HER2生物學(xué)亞型（HR陽(yáng)性/HER2陰性、HR陽(yáng)性/HER2陽(yáng)性、HR陰性/HER2陽(yáng)性、HR陰性/HER2陰性）進(jìn)行統計學(xué)分析。通過(guò)多因素比例風(fēng)險回歸模型，評估臨床病理和治療相關(guān)參數與結局的相關(guān)性。
結果，放療后中位隨訪(fǎng)65個(gè)月：
局部區域控制失敗率：20.8%（56例）
遠處轉移率：61.3%（165例）
5年局部區域控制率：77.3%
5年無(wú)遠處轉移生存率：45.6%
5年無(wú)病生存率：43.9%
5年總生存率：66.8%
多因素分析表明，生物學(xué)亞型為所有結局最重要的預后因素，三陰性（HR陰性/HER2陰性）患者與HR陽(yáng)性/HER2陰性患者相比：
5年局部區域控制率顯著(zhù)較低（58.3%比84.2%，風(fēng)險比：4.36，P<0.001）
5年無(wú)遠處轉移生存率顯著(zhù)較低（15.8%比63.0%，風(fēng)險比：4.28，P<0.001）
5年無(wú)病生存率顯著(zhù)較低（13.6%比59.7%，風(fēng)險比：3.92，P<0.001）
5年總生存率顯著(zhù)較低（22.3%比87.8%，風(fēng)險比：8.55，P<0.001）
局部區域控制率較低的相關(guān)其他因素包括非根治手術(shù)和僅受累區放療，不良生存的其他相關(guān)因素包括最初診斷淋巴結陽(yáng)性和淋巴引流區域復發(fā)。
因此，該研究結果表明，生物學(xué)亞型依然可以預測乳房切除術(shù)后孤立性局部區域復發(fā)補救放療后的局部區域控制和生存。值得注意的是，三陰性（HR陰性/HER2陰性）乳腺癌患者被證實(shí)局部區域控制失敗和隨后遠處轉移的風(fēng)險較高，并且雖然接受補救治療，但是生存率往往較低，需要采取更為積極的治療措施。
J Oncol. 2018 Sep 12;2018:4736263.
Outcomes Following Salvage Radiation and Systemic Therapy for Isolated Locoregional Recurrence of Breast Cancer after Mastectomy: Impact of Constructed Biologic Subtype.
Wang X, Ma J, Mei X, Yang Z, Yu X, Guo X, Zhang Z, Shao Z.
Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.
PURPOSE: This study examines factors associated with outcomes following salvage radiation and systemic therapy for breast cancer patients who developed isolated locoregional recurrence (ILRR) after mastectomy alone, while focusing on the prognostic significance of constructed biologic subtype in this setting.
METHODS AND MATERIALS: 269 postmastectomy patients in total treated for ILRR were included. Cumulative incidence of locoregional control (LRC), distant metastasis (DM)-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were calculated using Kaplan-Meier method. For statistical analysis, biologic subtypes were constructed from hormonal receptors (Rec) and HER2, consisting of Rec+/HER2-, Rec+/HER2+, Rec-/HER2+, and Rec-/HER2-. The association of clinic-pathological and treatment-related parameters with outcomes was evaluated using a Cox regression model.
RESULTS: At a median follow-up of 65 months, 56 (20.8%) patients failed to secure LRC after radiotherapy, and 165 patients (61.3%) developed DM. Overall, the actuarial 5-year LRC, DMFS, DFS, and OS rate was 77.3%, 45.6%, 43.9%, and 66.8%, respectively. Multivariate analysis revealed that constructed biologic subtype represented the most significant prognostic factor for any outcome. Compared to patients with Rec+/HER2- disease, those with Rec-/HER2- had significantly poorer 5-year LRC (84.2% versus 58.3%, HR = 4.36, P < 0.001) and worse survivals including 5-year DMFS (63.0% versus 15.8%, HR = 4.28, P < 0.001), DFS (59.7% versus 13.6%, HR=3.92, P < 0.001), and OS (87.8% versus 22.3%, HR = 8.55, P < 0.001). Other factors associated with reduced LRC were no radical surgery and involved field irradiation alone, whereas factors associated with poor survivals included positive nodes at primary diagnosis and regional recurrence.
CONCLUSIONS: Constructed biologic subtypes remained to be predictive of both disease control and survivals after salvage radiation for postmastectomy ILRR. Notably, Rec-/HER2- patients were demonstrated to be at high risk of locoregional failure and subsequent DM and tended to have worse survivals despite salvage therapies.
PMID: 30298090
PMCID: PMC6157175
DOI: 10.1155/2018/4736263
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