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Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0-1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database.

辅助化疗不能给 HR 阳性、 HER2-negative 、 pT1b-c/N0-1/M0 浸润性乳腺小叶癌带来生存获益: 基于 SEER 数据库的倾向评分匹配研究。

  • 影响因子:3.29
  • DOI:10.1186/s12885-020-6614-0
  • 作者列表:"Hu G","Hu G","Zhang C","Lin X","Shan M","Yu Y","Lu Y","Niu R","Ye H","Wang C","Xu C
  • 发表时间:2020-02-21
Abstract

BACKGROUND:The benefit of adjuvant chemotherapy in invasive lobular carcinoma (ILC) is still unclear. The objective of the current study was to elucidate the effectiveness of adjuvant chemotherapy in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1b-c/N0-1/M0 ILC. METHODS:Based on Surveillance, Epidemiology, and End-Results (SEER) database, we identified original 12,334 HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC patients, who were then divided into adjuvant chemotherapy group and control group. End-points were overall survival (OS) and breast cancer-specific mortality (BCSM). Aiming to minimize the selection bias of baseline characteristics, Propensity Score Matching (PSM) method was used. RESULTS:In a total of 12,334 patients with HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC, 1785 patients (14.5%) were allocated into adjuvant chemotherapy group and 10,549 (85.5%) into control group. Used PSM, the 1785 patients in adjuvant chemotherapy group matched to the 1785 patients in control group. By Kaplan-Meier survival analyses, we observed no beneficial effect of adjuvant chemotherapy on OS in both original samples (P = 0.639) and matched samples (P = 0.962), however, ineffective or even contrary results of adjuvant chemotherapy on BCSM both in original samples (P = 0.001) and in matched samples (P = 0.002). In both original and matched multivariate Cox models, we observed ineffectiveness of adjuvant chemotherapy on OS (hazard ratio (HR) for overall survival = 0.82, 95% confidence interval (CI) [0.62-1.09]; P = 0.172 and HR = 0.90, 95%CI [0.65-1.26]; P = 0.553, respectively), unexpectedly promoting effect of adjuvant chemotherapy on BCSM (HR = 2.33, 95%CI [1.47-3.67]; P = 0.001 and HR = 2.41, 95%CI [1.32-4.39]; P = 0.004, respectively). Standard surgery was beneficial to the survival of patients. Lymph node metastasis was detrimental to survival and radiotherapy brought survival benefit in original samples, but two issues had unobvious effect in matched samples. CONCLUSION:In this study, adjuvant chemotherapy did not improve survival for patients with HR-positive, HER2-negative pT1b-c/N0-1/M0 ILC.

摘要

背景: 辅助化疗对浸润性小叶癌 (ILC) 的益处仍不清楚。本研究的目的是阐明辅助化疗对激素受体 (HR) 阳性、人表皮生长因子受体 2 (HER2) 阴性、 pT1b-c/N0-1/M0 ILC。 方法: 基于监测流行病学学和最终结果 (SEER) 数据库,我们确定了 12,334 例 HR 阳性、 HER2-negative 、 pT1b-c/N0-1/M0 ILC 患者, 分为辅助化疗组和对照组。终点是总生存期 (OS) 和乳腺癌特异性死亡率 (BCSM)。旨在最小化基线特征的选择偏倚,使用倾向评分匹配 (PSM) 方法。 结果: 在 12,334 例 HR 阳性、 HER2-negative 、 pT1b-c/M0 ILC 患者中,1785 例 (14.5%) 患者被分配到辅助化疗组,10,549 例 (85.5%) 进入对照组。使用 PSM,辅助化疗组的 1785 例患者与对照组的 1785 例患者相匹配。通过 Kaplan-Meier 生存分析,我们在原始样本 (p = 0.639) 和匹配样本 (p = 0.962) 中未观察到辅助化疗对 OS 的有益影响,然而, 原始样本 (p = 0.001) 和匹配样本 (p = 0.002) 中 BCSM 辅助化疗的无效甚至相反结果。在原始和匹配的多变量 Cox 模型中,我们观察到辅助化疗对 OS 的无效性 (总体生存的风险比 (HR) = 0.82,95% 置信区间 (CI)) [0.62-1.09]; p = 0.172 和 hr = 0.90,95% CI [0.65-1.26]; p = 0.553), 辅助化疗对 BCSM 的促进作用出乎意料 (hr = 2.33,95% CI [1.47-3.67]; p = 0.001 和 hr = 2.41,95% CI [1.32-4.39]; p = 0.004)。标准手术有利于患者的生存。淋巴结转移对生存不利,放疗在原始样本中带来生存获益,但两个问题在匹配样本中效果不明显。 结论: 在这项研究中,辅助化疗并没有改善 HR 阳性患者的生存,HER2-negative 的 pT1b-c/N0-1/M0 ILC。

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