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Received:December 12, 2021 Published Online:September 20, 2022
Received:December 12, 2021 Published Online:September 20, 2022
中文摘要: 目的 探讨原发灶手术对激素受体阳性人表皮生长因素受体阴性（HR+HER2-）晚期乳腺癌总生存的影响及影响因素。方法 回顾性分析SEER数据库中2010年至2015年HR+HER2-晚期乳腺癌3 385例。倾向评分匹配（PSM）平衡混杂因素，Cox回归分析评估临床因素对预后的影响，Kaplan-Meier法描述总生存（OS）及乳腺癌特异性生存（BCSS），比较行原发灶手术（PTS组）和未行原发灶手术（NPTS组）的生存差异，比较单纯骨转移HR+HER2-晚期乳腺癌保留乳房手术（BCT组）与乳房全切术（ME组）的生存差异，log-rank进行检验。结果 多因素Cox分析显示年龄大、T分期晚、病理分级差、脑转移、肝转移、雌激素受体（ER）阴性、孕激素受体（PR）阴性是影响OS及BCSS的独立不利预后影响因素（P<0.05，P<0.01)；已婚、化疗、PTS是影响OS及BCSS的独立有利预后影响因素（P<0.05，P<0.01）。PSM前后HR+HER2-晚期乳腺癌PTS组较NPTS组均有生存获益（PSM前：χ2OS= 127.70，POS<0.01，χ2BCSS= 127.30，PBCSS<0.01；PSM后：χ2OS=72.81，POS<0.01，χ2BCSS=73.03，PBCSS<0.01）。PSM前后单纯骨转移HR+HER2-晚期乳腺癌BCT组较ME组生存获益更优（χ2OS=6.26，POS=0.01，χ2BCSS=4.33，PBCSS=0.04）；PSM后BTC组较ME组生存获益略高，但差异无统计学意义（χ2OS=2.81，POS =0.09，χ2BCSS=2.01，PBCSS =0.16）。结论 HR+HER2-晚期乳腺癌行原发灶肿瘤手术与改善生存相关，且单纯骨转移行保留乳房手术有生存期获益趋势。
Abstract:Objective To investigate the effect of primary lesion surgery on the overall survival of hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer and its influencing factors. Methods The 3 385 cases of HR+HER2- advanced breast cancer from 2010 to 2015 in SEER database were analyzed retrospectively. Propensity scores were matched to balance confounding factors, and Cox regression analysis was used to evaluate the impact of clinical factors on prognosis. Kaplan-Meier method describe the overall survival （OS） and breast cancer specific survival （BCSS）. The survival difference between primary lesion surgery (PTS group) and non PTS (NPTS group), and that between simple bone metastasis HR+HER2- breast conserving surgery (BCT group) and total mastectomy (ME group) for advanced breast cancer were compared. Results Multivariate Cox analysis showed that older age, late T stage, poor pathological grade, brain metastasis, liver metastasis, estrogen receptor (ER) negative, progesterone receptor (PR) negative were independent adverse prognostic factors affecting OS and BCSS （P<0.05,P<0.01）. Married, chemotherapy and PTS were independent favorable prognostic factors affecting OS and BCSS（P<0.05,P<0.01）. HR+HER2- advanced breast cancer before and after PSM, PTS group had survival benefits compared with NPTS group (before PSM, χ2OS= 127.70, POS<0.01, χ2BCSS= 127.30,PBCSS<0.01; after PSM, χ2OS=72.81,POS<0.01, χ2BCSS=73.03, PBCSS<0.01). Before PSM, the BCT group with simple bone metastases in HR+HER2- advanced breast cancer had better survival benefit than the ME group(χ2OS=6.26，POS=0.01；χ2BCSS=4.33，PBCSS=0.04). After PSM, the survival benefits of BCT group were slightly higher than that of ME group without significant difference (χ2OS=2.81, POS=0.09; χ2BCSS=2.01, PBCSS=0.16). Conclusion Primary tumor surgery for HR+HER2- advanced breast cancer is associated with improved survival, and breast conserving surgery for simple bone metastasis has a trend of survival benefit.
keywords: Hormone receptor Human epidermal growth factor receptor 2 Advanced breast cancer Primary lesion surgery Bone metastasis Survival
文章编号： 中图分类号：R655.8 文献标志码：A
基金项目:四川省科技厅科研专项资金计划项目（14JC0197-LH38）
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