0-3个腋窝淋巴结阳性的中危乳腺癌患者乳腺切除术后放射治疗：使用真实世界数据模拟SUPREMO试验

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2025-03-11 DOI:10.1016/j.clbc.2025.03.007

Sarah E. Kulkarni , Sagar A. Patel , Chen Jiang , Lara Schwieger , Lauren M. Postlewait , Cletus A. Arciero , Theresa W. Gillespie , Yuan Liu

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引用次数: 0

摘要

目的：模拟选择性使用乳房切除术后放疗（SUPREMO） III期临床试验，使用真实世界数据评估乳房切除术后放疗（PMRT）对中危乳腺癌患者总生存期（OS）的影响。患者和方法：使用国家癌症数据库，2006年至2013年间诊断为中危乳腺癌的女性(定义为pT1-2N1；pT3N0;（pT2N0和III级或伴有淋巴血管浸润）和0-3阳性腋窝淋巴结，接受全乳切除术，被确定为符合SUPREMO试验方案并纳入本研究。采用多变量logistic回归、Cox比例风险回归、处理权重稳定逆概率等方法探讨PMRT与OS的关系。使用多变量相互作用模型探讨了PMRT在亚组中的作用。结果：共纳入49335例患者，其中6882例（13.9%）接受了PMRT治疗。T3N0期癌症、1-3个腋窝淋巴结阳性或手术切缘阳性的患者更有可能接受PMRT。总体而言，PMRT与OS无显著改善相关（HR: 0.98, 95% CI, 0.92-1.04）。然而，接受PMRT治疗的T3N0期癌症患者的生存率有所提高（HR: 0.72, 95% CI: 0.58-0.89）。结论：尽管PMRT可能与所有0-3期腋窝淋巴结阳性的中危乳腺癌患者的OS改善无关，但T3N0期癌症患者亚组似乎受益于PMRT。该研究的回顾性引入了一些不确定性，但SUPREMO试验的初步结果支持这些结果。

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Postmastectomy Radiation Therapy for Intermediate-Risk Breast Cancer Patients With 0-3 Positive Axillary Lymph Nodes: Emulating the SUPREMO Trial Using Real-World Data

Purpose

To emulate the Selective Use of Postoperative Radiotherapy After Mastectomy (SUPREMO) phase III clinical trial using real-world data to assess the impact of postmastectomy radiation therapy (PMRT) on overall survival (OS) among patients with intermediate-risk breast cancer.

Patients and Methods

Using the National Cancer Database, women diagnosed between 2006 and 2013 with intermediate-risk breast cancer (defined as pT1-2N1; pT3N0; or pT2N0 and grade III or with lymphovascular invasion) and 0-3 positive axillary lymph nodes, who underwent total mastectomy, were identified as being in accordance with the SUPREMO trial protocol and included in this study. Multivariable logistic regression, Cox proportional hazards regression, and stabilized inverse probability of treatment weighting were used to explore the relationship between PMRT and OS. The effects of PMRT within subgroups were explored using multivariable interaction models.

Results

In total, 49335 patients were included in the study, with 6882 (13.9%) receiving PMRT. Patients with stage T3N0 cancer, 1-3 positive axillary lymph nodes, or positive surgical margins were more likely to receive PMRT. Overall, PMRT was associated with no significant improvement in OS (HR: 0.98, 95% CI, 0.92-1.04). However, improved survival was observed among women with stage T3N0 cancer who received PMRT (HR: 0.72, 95% CI, 0.58-0.89).

Conclusion

Although PMRT may not be associated with improved OS among all intermediate-risk breast cancer patients with 0-3 positive axillary lymph nodes, the subgroup of patients with stage T3N0 cancer seemed to benefit from PMRT. The study's retrospective nature introduces some uncertainty, but preliminary findings of the SUPREMO trial support these results.

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.