对于淋巴结阴性三阴性乳腺癌患者，乳房切除术后放疗存在争议。
2018年12月20日，欧洲放射治疗与肿瘤学会《放射治疗与肿瘤学》在线发表美国休斯顿卫理公会医院、匹兹堡阿勒格尼总医院的研究报告，根据美国当代大样本数据库分析了全国临床实践模式，并探讨了乳房切除术后放疗对淋巴结阴性三阴性乳腺癌患者生存的影响。
该研究根据美国国家癌症研究所全国癌症数据库，对2004～2014年接受乳房切除术的非转移性、淋巴结阴性、三阴性乳腺癌女性进行查询，对乳房切除术后放疗的使用率进行评定。通过多因素逻辑回归，确定乳房切除术后放疗的影响因素。通过生存曲线分析，并按病理T分期进行分层，比较患者接受乳房切除术后放疗或乳房切除术后观察的总生存。通过多因素比例风险回归模型，确定总生存的影响因素。
结果，符合入选标准的患者共计1万4464例，其中接受、未接受乳房切除术后放疗的患者分别为1569例、1万2895例（10.8%、89.2%）。
对于病理T分期不同的患者，乳房切除术后放疗的使用率显著不同：
病理T1期：5.7%
病理T2期：11.2%
病理T3期：51.6%
病理T4期：42.5%
使用与未使用乳房切除术后放疗相比，病理T3期患者的总生存率较高，其他病理T分期患者的总生存率相似。
患者年龄越大，乳房切除术后放疗的使用率越低；患者病理T分期高、手术切缘阳性，与使用乳房切除术后放疗相关。
根据多因素分析，年龄大、T分期高、手术切缘阳性，与总生存较差相关。
因此，根据该迄今为止评估乳房切除术后放疗用于淋巴结阴性三阴性乳腺癌患者的最大研究结果，病理T1和T2期患者的乳房切除术后放疗使用率较低。此外，乳房切除术后放疗的总生存获益仅见于病理T3期患者，未见于其他T分期患者。推荐开展前瞻研究进一步阐明淋巴结阴性三阴性乳腺癌患者对乳房切除术后放疗的获益。
Radiother Oncol. 2018 Dec 20; 132:48-54. [Epub ahead of print]
Postmastectomy radiation therapy for triple negative, node-negative breast cancer.
Waqar Haque, Vivek Verma, Andrew Farach, E. Brian Butler, Bin S. Teh.
Houston Methodist Hospital, USA; Allegheny General Hospital, Pittsburgh, USA.
HIGHLIGHTS
Use of PMRT is low for all node negative TNBC patients.
Higher PMRT rates are observed for patients with T3 or T4 disease.
PMRT was associated with improved OS only for T3 patients.
PURPOSE: The use of post-mastectomy radiation therapy (PMRT) for patients with node-negative, triple negative breast cancer (TNBC) is controversial. This study of a large, contemporary US database described national practice patterns and addressed the impact of PMRT on survival for patients with node-negative TNBC.
METHODS: The National Cancer Data Base was queried (2004-2014) for women with non-metastatic TNBC with pT1-4N0M0 disease undergoing mastectomy. Use of PMRT was assessed. Multivariable logistic regression ascertained factors associated with PMRT use. The Kaplan-Meier analysis evaluated overall survival (OS) between patients managed with either PMRT or observation following mastectomy when stratifying by pT stage. Cox proportional hazards modeling determined variables associated with OS.
RESULTS: A total of 14,464 patients met the selection criteria; of these, 1,569 (10.8%) received PMRT, whereas 12,895 (89.2%) did not receive PMRT. Use of PMRT varied significantly with pT stage, with only 5.7% of T1 patients undergoing PMRT, while 51.6% of patients with T3 disease underwent PMRT. Use of PMRT was associated with superior OS for patients with pT3 disease but not for patients with other T stages. Greater age was associated with decreased likelihood of PMRT use, while increased T stage and positive surgical margins were associated with use of PMRT. On multivariate analysis, increased age, T stage, and positive surgical margins were associated with worse OS.
CONCLUSIONS: In the largest study to date evaluating the use of PMRT in patients with node-negative TNBC, the use of PMRT was low in patients with T1 and T2 disease. Additionally, while an OS benefit was observed with the use of PMRT in patients with T3 disease, there was no benefit with the use of PMRT in other T stage groups. Further prospective studies are recommended to further elucidate the benefit on PMRT in patients with node-negative TNBC.
DOI: 10.1016/j.radonc.2018.11.012
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