目的:研究台灣 N1 乳癌病人進行全乳房切除後放射治療是否影響病人的預後。材料與方法:收集全國癌症登記、全民健保及死亡檔資料,西元 2004-2009 年新登記的乳癌病人,選取早期乳癌(T1-2)並有 N1 局部淋巴結轉移的病人共 6,257 位,在接受乳房全切除手術後(Post-mastectomy),將有無放射線治療(post-mastectomy radiotherapy, PMRT)經傾向分數配對(propensity score matching, PSM)後,分析其生存率以及評估其危險因子。結果:在所選族群中,全乳切除手術後放射治療組病人共 2,866(46%)人,無放射治療組共3,391(54%),經傾向分數配對後,兩組分別為 2,267(50%)人。接受放射治療組的病人比沒有放射線治療的病人,有較佳的整體存活率(Overall survival, 5 year 92.0% vs. 90.7%; 8 year87.9% vs. 81.5%, p= 0.001)與無病存活率(Disease-free survival, 5 year 79.3% vs. 74.8%,8year 74.2% vs. 65.8%, p= 0.0002)。而在危險因子評估中,淋巴結侵犯數目與病理 T2,此兩種危險因子,在整體存活率(Overall survival) 以及無病存活率(Disease-free survival)達到統計顯著差異。結論:此次研究利用癌登資料庫分析 N1 病人接受全乳切除手術後之放射治療,有接受放射治療的病人有較佳之整體存活率及無病存活率,而腫瘤大小和淋巴結侵犯數目為影響存活之因子,唯此研究未分析局部淋巴結照射之範圍,日後可望進一步再分析。
Purpose : The application of post-mastectomy radiotherapy (PMRT) in N1 breast cancer patients is still no consensus according to the St. Gallen meeting in 2015. The aim of this study is to investigate the impact of PMRT on survivals in N1 breast cancer patients. Materials and Methods : Data were obtained from the cancer registry database and national health insurance claim data in Taiwan. We selected early breast cancer (T1-T2) and N1 lymph node metastasis patient treated with and without PMRT. Total 6,257 patients diagnosed between 2004 and 2009 were identified. We compared overall survival and disease-free survival between patients with and without PMRT. Propensity score matching and sensitivity analysis were performed. Result : We identified 2,866 (46%) patients with PMRT and 3,391 (54%) patients without PMRT. After the propensity score matching, 2,267 patients for each group were included in the analysis. The PMRT group showed significantly better overall survival and disease-free survival. Sensitivity analysis showed that pathology T2 stage and numbers of lymph node involved were statistically associated with poorer outcomes. Conclusion : Our study suggests that N1 breast cancer patients with PMRT have better overall survival and disease-free survival than those patients without PMRT after risk factors adjusted by the propensity score matching in the nationwide population-based study.
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