基于SEER数据库的局部晚期乳腺癌新辅助化疗后行保留乳房手术与乳房切除术患者的预后分析  

Prognostic Analysis of Patients Undergoing Breast-Conserving Surgery and Mastectomy After Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer Based on SEER Database

作　　者：聂贤丽 邓建 权毅 NIE Xianli;DENG Jian;QUAN Yi(Department of Breast Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院乳腺外科,四川泸州646000

出　　处：《河南医学研究》2021年第32期5953-5960,共8页Henan Medical Research

摘　　要：目的随着新辅助化疗在临床上的应用增加,越来越多的专家提出乳腺癌新辅助化疗后接受保留乳房手术是否安全的疑虑。因此,本研究基于SEER数据库分析局部晚期乳腺癌新辅助化疗后行保留乳房手术与乳房切除术患者的预后。方法选取美国国立癌症研究所SEER数据库2010—2015年初诊为局部晚期乳腺癌且接受新辅助化疗的女性患者4 965例进行回顾性分析,其中1 734例接受保留乳房手术,3 231例接受乳房切除术。通过倾向评分匹配(PSM)控制混杂因素,利用Kaplan-Meier法分析总生存率(OS)和乳腺癌特异性生存率(BCSS),单因素和多因素Cox回归分析新辅助化疗后局部晚期乳腺癌患者预后的影响因素,GraphPad Prism 8软件绘制生存曲线图。结果 PSM后多因素Cox回归分析发现种族(OS:HR=1.134,95%CI 1.031~1.248,P=0.010。BCSS:HR=1.146,95%CI 1.033~1.272,P=0.010)、婚姻状态(OS:HR=1.191,95%CI 1.058~1.340,P=0.004。BCSS:HR=1.162,95%CI 1.021~1.322,P=0.023)、N分期(OS:HR=1.434,95%CI 1.235~1.666,P<0.001。BCSS:HR=1.630,95%CI 1.381~1.924,P<0.001)、孕激素受体表达状态(OS:HR=1.533,95%CI 1.268~1.853,P<0.001。BCSS:HR=1.618,95%CI 1.317~1.988,P<0.001)、手术方式(OS:HR=1.165,95%CI 1.020~1.330,P=0.024。BCSS:HR=1.185,95%CI 1.026~1.370,P=0.021)是影响OS及BCSS预后的独立影响因素,年龄(OS:HR=1.202,95%CI 1.092~1.323,P<0.001)、雌激素受体表达状态(OS:HR=1.243,95%CI 1.033~1.496,P=0.021)是OS预后的独立影响因素。PSM前后生存曲线表明局部晚期乳腺癌新辅助化疗后行保留乳房手术比行乳房切除术患者均有生存获益(保留乳房手术组与乳房切除术组比较,PSM前χ_(os)^(2)=101.317,P_(OS)<0.001,χ_(os)^(2)=84.559,P_(BCSS)<0.001;PSM后χ_(os)^(2)=7.563,P_(OS)=0.006,χ_(os)^(2)=7.376,P_(BCSS)=0.007)。结论局部晚期乳腺癌新辅助化疗后保留乳房手术是可行的,接受保留乳房手术较乳房切除术患者有生存获益。Objective With the increasing clinical application of neoadjuvant chemotherapy,more and more experts have proposed whether it is safe to undergo breast-conserving surgery after neoadjuvant chemotherapy for breast cancer.Therefore,this study is based on the SEER database to analyze the prognosis of breast-conserving surgery and mastectomy in locally advanced breast cancer patients receiving neoadjuvant chemotherapy.Methods A retrospective analysis was performed on 4 965women who were newly diagnosed with locally advanced breast cancer and received neoadjuvant chemotherapy from the National Cancer Institute SEER database from 2010 to 2015.Among them 1 734 underwent breast-conserving surgery and 3 231underwent mastectomy.The confounders were controlled by propensity score matching (PSM),Kaplan-Meier analyzed overall survival (OS) and breast cancer specific survival (BCSS),single and multifactor Cox regression analyzed influencing factors in patients with locally advanced breast cancer after neoadjuvant chemotherapy,and GraphP ad Prism 8 software drew survival curves.Results After PSM multifactor Cox regression analysis found race (OS:HR=1.134,95%CI 1.031-1.248,P=0.010.BCSS:HR=1.146,95%CI 1.033-1.272,P=0.010),marria status (OS:HR=1.191,95%CI 1.058-1.340,P=0.004.BCSS:HR=1.162,95%CI 1.021-1.322,P=0.023),N staging (OS:HR=1.434,95%CI 1.235-1.666,P<0.001.BCSS:HR=1.630,95%CI 1.381-1.924,P<0.001),progesterone receptor expression status (OS:HR=1.533,95%CI 1.268-1.853,P<0.001.BCSS:HR=1.618,95%CI 1.317-1.988,P<0.001),operation method (OS:HR=1.165,95%CI 1.020-1.330,P=0.024.BCSS:HR=1.185,95%CI 1.026-1.370,P=0.021) were independent factors affecting OS and BCSS prognosis.Age (OS:HR=1.202,95%CI 1.092-1.323,P<0.001),estrogen receptor expression status (OS:HR=1.243,95%CI 1.033-1.496,P=0.021) were independent impact factors for OS prognosis.The survival curve before and after PSM showed the patients with locally advanced breast cancer who underwent breastconserving surgery after neoadjuvant chemotherapy had a survival benefit compare

关 键 词：局部晚期乳腺癌 新辅助化疗 保留乳房手术 乳房切除手术 

分 类 号：R655.8[医药卫生—外科学]