基于SEER数据库分析激素受体对Ⅳ期男性乳腺癌原发病灶切除获益影响
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摘要
目的目前对于Ⅳ期男性乳腺癌原发灶手术切除考虑谨慎,但原发灶手术有可能够提高生存率。分析手术与否与Ⅳ期男性乳腺癌预后获益有何相关,并分析其获益因素,为男性乳腺癌诊治提供依据。方法提取美国国立癌症研究所数据库(Surveillance,Epidemiology,and End Results,SEER)1990-01-01-2009-12-31共344例Ⅳ期男性乳腺癌患者数据,采用t检验和χ2检验进行单变量描述性分析,Cox比例风险模型进行单因素分析及多因素分析,以确定与生存的独立因素。Log-rank检验并绘制Kaplan-Meier生存曲线分析手术对预后的影响。结果单因素分析发现,原发部位手术能够使Ⅳ期男性乳腺癌得到生存获益(手术与非手术比较,P<0.001),患者诊断年龄(>65岁/≤65岁,HR=1.580,95%CI:1.268～1.971,P<0.001)与雌激素受体(阳性/阴性,HR=1.965,P<0.001)和孕激素受体(阳性/阴性,HR=1.312,P<0.001)是影响Ⅳ期男性乳腺癌预后的主要保护因素;多因素分析发现,患者年龄、雌激素受体状态、手术与否是显著影响患者预后,均P<0.001。结论Ⅳ期男性乳腺癌患者接受原发灶手术后提高了患者的生存率,其中雌激素受体/孕激素受体阳性患者有生存优势,可为今后男性乳腺癌诊治的参考。
OBJECTIVE Nowadays treatment in stageⅣ male breast cancer for primary tumors resection is not usually considered.Primary tumors surgery might improve the survival rate.This study was to investigate the correlation between primary tumor surgery and prognosis benefit of stageⅣ male breast cancer and find out the factors of benefit.Provide the basis for the diagnosis and treatment of male breast cancer.METHODS By Kaplan-Meier method,Log-rank test and Cox regression model to analyze contributing factors in OS about male breast cancer patients in the SEER database from January 1 st 1990 to December 31 st 2009.Univariate descriptive analysis was performed by t-test and chi-square test,and statistically significant variables were input into Cox regression analysis to determine independent association with survival.The prognostic benefit factors of stageⅣ male breast cancer were analyzed by Log-rank test and KaplanMeier survival curve.RESULTS Univariate analysis found that the primary site operation could make Ⅳ mate breast cancer patients get breast cancer survival benefit(surgical vs non-surgical,P<0.001).Age(HR=1.580,95%CI=1.268-1.971,P<0.001),ER(HR=1.965,P<0.001)and PR(HR=1.312,P<0.001)were the main factors influencing theⅣ period prognosis of male breast cancer.Multivariate analysis showed that age,ER status and surgical status of the patients significantly affected the prognosis of the patients(all P<0.001).CONCLUSIONS The survival advantage is provided for the patients diagnosed as stageⅣ male breast cancer after primary tumor surgery,and ER/PR positivity is the factor that benefited the primary surgery.It can be a reference for the diagnosis and treatment of male breast cancer in the future.
OBJECTIVE Nowadays treatment in stageⅣ male breast cancer for primary tumors resection is not usually considered.Primary tumors surgery might improve the survival rate.This study was to investigate the correlation between primary tumor surgery and prognosis benefit of stageⅣ male breast cancer and find out the factors of benefit.Provide the basis for the diagnosis and treatment of male breast cancer.METHODS By Kaplan-Meier method,Log-rank test and Cox regression model to analyze contributing factors in OS about male breast cancer patients in the SEER database from January 1 st 1990 to December 31 st 2009.Univariate descriptive analysis was performed by t-test and chi-square test,and statistically significant variables were input into Cox regression analysis to determine independent association with survival.The prognostic benefit factors of stageⅣ male breast cancer were analyzed by Log-rank test and KaplanMeier survival curve.RESULTS Univariate analysis found that the primary site operation could make Ⅳ mate breast cancer patients get breast cancer survival benefit(surgical vs non-surgical,P<0.001).Age(HR=1.580,95%CI=1.268-1.971,P<0.001),ER(HR=1.965,P<0.001)and PR(HR=1.312,P<0.001)were the main factors influencing theⅣ period prognosis of male breast cancer.Multivariate analysis showed that age,ER status and surgical status of the patients significantly affected the prognosis of the patients(all P<0.001).CONCLUSIONS The survival advantage is provided for the patients diagnosed as stageⅣ male breast cancer after primary tumor surgery,and ER/PR positivity is the factor that benefited the primary surgery.It can be a reference for the diagnosis and treatment of male breast cancer in the future.
引文
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[2] Cordeiro E,Jackson TD,Elnahas A.Higher rate of breast surgery complications in patients with metastatic breast cancer:an analysis of the NSQIP database[J].Ann Surg Oncol,2014,21(10):3167-3172.
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[13] Li S,Zhao J,Zhu L,et al.Development and validation of a nomogram predicting the overall survival of stageⅣbreast cancer patients[J].Cancer Med,2017,6(11):2586-2594.
[14] Quinn EM,Kealy R,O'Meara S,et al.Is there a role for locoregional surgery in stageⅣbreast cancer?[J].Breast,2015,24(1):32-37.
[15] Fields RC,Jeffe DB,Trinkaus K,et al.Surgical resection of the primary tumor is associated with increased long-term survival in patients with stageⅣbreast cancer after controlling for site of metastasis[J].Ann Surg Oncol,2007,14(12):3345-3351.
[16] Lang JE,Tereffe W,Mitchell MP,et al.Primary tumor extirpation in breast cancer patients who present with stageⅣdisease is associated with improved survival[J].Ann Surg Oncol,2013,20(6):1893-1899.
[17] Akay CL,Ueno NT,Chisholm GB,et al.Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stageⅣinflammatory breast cancer[J].Cancer,2014,120(9):1319-1328.
[18] Blanchard DK,Shetty PB,Hilsenbeck SG.Association of surgery with improved survival in stageⅣbreast cancer patients[J].Ann Surg Oncol,2008,247(5):732-738.
[19] Neuman HB,Morrogh M,Gonen M,et al.StageⅣbreast cancer in the era of targeted therapy:does surgery of the primary tumor matter?[J].Cancer,2010,116(5):1226-1233.
[20] Muzaffar M,Kachare S.Impact of primary tumor surgery in stageⅣmale breast cancer[EB/OL].Clin Breast Cancer,2017,17(3):e143-e149[2016-11-01].http://dx.doi.org/10.1016/j.clbc.2016.11.001.
[21] Soran A,Ozmen V,Ozbas S,et al.Randomized trial comparing resection of primary tumor with no surgery in stageⅣbreast cancer at presentation:Protocol MF07-01[J].Ann Surg Oncol,2018,25(11):3141-3149.
[22]雷蕾,王娴,王晓稼.初治Ⅳ期乳腺癌原发肿瘤手术研究现状[J].中国肿瘤外科杂志,2017,9(3):141-144.
[2] Cordeiro E,Jackson TD,Elnahas A.Higher rate of breast surgery complications in patients with metastatic breast cancer:an analysis of the NSQIP database[J].Ann Surg Oncol,2014,21(10):3167-3172.
[3] Xie Y,Lv X,Luo C,et al.Surgery of the primary tumor improves survival in women with stageⅣbreast cancer in Southwest China:A retrospective analysis[EB/OL].Medicine,2017,96(22):e7048[2017-05-07].http://dx.doi.org/10.1097/MD.0000000000007048.
[4] Babiera GV,Rao R,Feng L,et al.Effect of primary tumor extirpation in breast cancer patients who present with stageⅣdisease and an intact primary tumor[J].Ann Surg Oncol,2006,13(6):776-782.
[5] Fields EC,DeWitt P,Fisher CM.Management of male breast cancer in the United States:a surveillance,epidemiology and end results analysis[J].Int J Radiat Oncol Biol Phys,2013,87(4):747-752.
[6] Cloyd JM,Hernandez-Boussard T.Outcomes of partial mastectomy in male breast cancer patients:analysis of SEER,1983-2009[J].Ann Surg Oncol,2013,20(5):1545-1550.
[7] Lumpectomy in male patients with breast cancer[J].Ann Surg Oncol,2013,20(8):2460-2461.
[8] Shien T,Kinoshita T,Shimizu C,et al.Primary tumor resection improves the survival of younger patients with metastatic breast cancer[J].Oncol Rep,2009,21(3):827-832.
[9] Pathy NB,Verkooijen HM,Taib NA,et al.Impact of breast surgery on survival in women presenting with metastatic breast cancer[J].Br J Surg,2011,98(11):1566-1572.
[10] Dominici L,Najita J,Hughes M,et al.Surgery of the primary tumor does not improve survival in stageⅣbreast cancer[J].Breast Cancer Res Treat,2011,129(2):459-465.
[11] Rashaan ZM,Bastiaannet E,Portielje JE,et al.Surgery in metastatic breast cancer:patients with a favorable profile seem to have the most benefit from surgery[J].Eur J Surg Oncol,2012,38(1):52-56.
[12] Badwe R,Hawaldar R,Nair N,et al.Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer:an open-label randomised controlled trial[J].Lancet Oncol,2015,16(13):1380-1388.
[13] Li S,Zhao J,Zhu L,et al.Development and validation of a nomogram predicting the overall survival of stageⅣbreast cancer patients[J].Cancer Med,2017,6(11):2586-2594.
[14] Quinn EM,Kealy R,O'Meara S,et al.Is there a role for locoregional surgery in stageⅣbreast cancer?[J].Breast,2015,24(1):32-37.
[15] Fields RC,Jeffe DB,Trinkaus K,et al.Surgical resection of the primary tumor is associated with increased long-term survival in patients with stageⅣbreast cancer after controlling for site of metastasis[J].Ann Surg Oncol,2007,14(12):3345-3351.
[16] Lang JE,Tereffe W,Mitchell MP,et al.Primary tumor extirpation in breast cancer patients who present with stageⅣdisease is associated with improved survival[J].Ann Surg Oncol,2013,20(6):1893-1899.
[17] Akay CL,Ueno NT,Chisholm GB,et al.Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stageⅣinflammatory breast cancer[J].Cancer,2014,120(9):1319-1328.
[18] Blanchard DK,Shetty PB,Hilsenbeck SG.Association of surgery with improved survival in stageⅣbreast cancer patients[J].Ann Surg Oncol,2008,247(5):732-738.
[19] Neuman HB,Morrogh M,Gonen M,et al.StageⅣbreast cancer in the era of targeted therapy:does surgery of the primary tumor matter?[J].Cancer,2010,116(5):1226-1233.
[20] Muzaffar M,Kachare S.Impact of primary tumor surgery in stageⅣmale breast cancer[EB/OL].Clin Breast Cancer,2017,17(3):e143-e149[2016-11-01].http://dx.doi.org/10.1016/j.clbc.2016.11.001.
[21] Soran A,Ozmen V,Ozbas S,et al.Randomized trial comparing resection of primary tumor with no surgery in stageⅣbreast cancer at presentation:Protocol MF07-01[J].Ann Surg Oncol,2018,25(11):3141-3149.
[22]雷蕾,王娴,王晓稼.初治Ⅳ期乳腺癌原发肿瘤手术研究现状[J].中国肿瘤外科杂志,2017,9(3):141-144.