保乳手术＋放疗已被证明对早期乳腺癌至少提供与乳房切除术相似的预后。然而，对于三阴性乳腺癌患者的研究相对较少。
2016年12月16日，美国《肿瘤标靶》在线发表福建医科大学附属协和医院宋传贵、复旦大学（上海医学院）附属肿瘤医院邵志敏等学者的人群研究报告，调查了保乳手术＋放疗、乳房切除术对于三阴性乳腺癌患者的不同结局（转归）。
该研究利用监测、流行病学与最终结果（SEER）数据库，将2010～2014年11514例确诊三阴性乳腺癌的女性病例分为保乳手术＋放疗组（5469例）和乳房切除术组（6045例），进行了两组之间的生存比较，观察终点为乳腺癌特异性生存和总生存。
结果发现，在整个队列中，保乳手术＋放疗患者的乳腺癌特异性生存和总体生存显著优于乳房切除术患者（对数秩P值均＜0.001）。当根据年龄、组织学分级、TNM分期、肿瘤大小、淋巴结状态对三阴性乳腺癌患者进行分层时，保乳手术＋放疗组大多数患者的生存优于乳房切除术组患者，除了Ⅰ级（乳腺癌特异性生存和总体生存，对数秩P值均为0.830）和Ⅰ期（乳腺癌特异性生存、总生存，对数秩P值分别为0.127、0.093）患者。此外，在通过多变量Cox比例风险分析校正混杂变量后，保乳手术＋放疗的乳腺癌特异性生存和总生存仍然略有优势。
因此，根据对SEER数据的研究，保乳手术＋放疗与乳房切除术相比，三阴性乳腺癌患者的乳腺癌特异性生存和总生存至少相似。该研究为外科医生提供了保乳手术＋放疗可用于三阴性乳腺癌患者的进一步证据。
Oncotarget. 2016 Dec 16. [Epub ahead of print]
The different outcomes between breast-conserving surgery and mastectomy in triple-negative breast cancer: a population-based study from the SEER 18 database.
Chen QX, Wang XX, Lin PY, Zhang J, Li JJ, Song CG, Shao ZM.
Affiliated Union Hospital, Fujian Medical University, Fuzhou, China; Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
Breast-conserving surgery (BCS) including radiotherapy (RT) has been demonstrated to provide at least equivalent prognosis to mastectomy in early-stage breast cancer. However, studies on triple-negative breast cancer (TNBC) patients are relatively scarce. The current population-based study aimed to investigate the distinct outcomes between BCS+RT and mastectomy in patients with TNBC. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled 11,514 female TNBC cases diagnosed during the years 2010-2013. Those patients were subdivided into BCS+RT (5,469) and mastectomy groups (6,045), and we conducted a survival comparison between the two groups. The endpoints were breast cancer-specific survival (BCSS) and overall survival (OS). In the overall cohort, patients with BCS+RT exhibited distinctly better breast cancer-specific survival (BCSS) (log-rank, p < 0.001) and overall survival (OS) (log-rank, p < 0.001) than did mastectomy patients. When stratifying the TNBC patients according to age, histology grade, TNM stage, tumor size, and lymph node (LN) status, most patients in the BCS+RT group presented with better survival than did the patients in the mastectomy group, except for the grade I (log-rank, p = 0.830, both BCSS and OS) and stage I (log-rank, BCSS, p = 0.127; OS, p = 0.093) patients. In addition, after adjusting for confounding variables by multivariable Cox proportional hazard analysis, BCS+RT still tended to present with higher BCSS and OS. In conclusion, from our study on SEER data, BCS+RT displayed elevated BCSS and OS in TNBC patients compared to mastectomy, at least equally. Our study provided further evidence for surgeons that BCS with RT is available for TNBC patients.
KEYWORDS: breast cancer-specific survival; breast-conserving surgery; mastectomy; overall survival; triple-negative breast cancer
PMID: 27999201
DOI: 10.18632/oncotarget.13976
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