三阴性浸润性小叶癌病人保乳手术联合放疗与乳房全切术的预后对比：基于SEER数据库的研究

doi:10.16139/j.1007-9610.2025.03.12

摘要/Abstract

摘要：

目的：探索三阴性浸润性小叶癌（TN-ILC）病人保乳手术联合放疗（BCS+RT）与乳房全切术的预后差异。方法：回顾性分析2006—2018年SEER数据库中2 386例接受手术的TN-ILC女性病人，采用倾向评分匹配（PSM，1∶1，卡钳值0.02）均衡基线特征（年龄、组织学分级、AJCC分期等），通过Kaplan-Meier法和COX回归分析比较乳腺癌特异性生存（BCSS）和总生存（OS）。结果：PSM后获得1 056对病人，BCS+RT组BCSS和OS显著优于全切组（均P<0.001）。分层分析显示，除组织学Ⅰ级和肿瘤Ⅰ期外，BCS+RT在各亚组中均具生存优势。多因素分析证实BCS+RT为独立保护因素（BCSS：HR=0.682，OS：HR=0.607，均P<0.001）。结论：TN-ILC病人中，BCS+RT 较乳房全切术显著改善生存，支持将BCS+RT作为符合条件病人的首选治疗策略。

关键词: 三阴性浸润性小叶癌, 保乳手术, 乳房全切术, 总生存率, 乳腺癌特异性生存率

Abstract:

Objective To investigate the prognosis of patients with triple-negative invasive lobular carcinoma (TN-ILC) undergoing breast-conserving surgery combined with radiotherapy (BCS+RT) versus total mastectomy. Methods A retrospective analysis was performed for 2 386 female patients with TN-ILC who underwent surgery in the SEER database from 2006 to 2018, and the baseline characteristics (age, histological grade, AJCC stage, etc.) were balanced by propensity score matching (PSM, 1∶1, caliper value 0.02), and breast cancer-specific survival (BCSS) and overall survival (OS) were compared by Kaplan-Meier method and COX regression analysis. Results A total of 1 056 pairs of patients were obtained after PSM, and the BCS+RT group had significantly better BCSS and OS than the total mastectomy group (both P<0.001). Stratified analyses showed that BCS+RT had a survival advantage in all subgroups except histologic grade Ⅰ and tumor stage Ⅰ. Multivariate analysis confirmed that BCS+RT was an independent protective factor (BCSS: HR=0.682, OS: HR=0.607, both P<0.001). Conclusions BCS+RT significantly improves survival compared with total mastectomy in patients with TN-ILC, supporting BCS+RT as the preferred treatment strategy for eligible patients.

Key words: Triple-negative invasive lobular carcinoma(TN-ILC), Breast-conserving surgery(BCS), Total mastectomy, Overall survival(OS), Breast cancer-specific survival(BCSS)

中图分类号:

R737.9

王新平, 余准, 袁帅, 汤永喆. 三阴性浸润性小叶癌病人保乳手术联合放疗与乳房全切术的预后对比：基于SEER数据库的研究[J]. 外科理论与实践, 2025, 30(03): 256-263.

WANG Xinping, YU Zhun, YUAN Shuai, TANG Yongzhe. Prognostic comparison between breast-conserving surgery combined with radiotherapy and total mastectomy in patients with triple-negative invasive lobular carcinoma: a SEER database-based study[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 256-263.

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Characteristics		BCS+RT(n=1 124)	Mastectomy（n=1 262）	Total(n=2 386)	χ² value	P value
Median follow-up (months)		27（10-48）	29(11-49)	28(10-48)
Median age (years)		51(43-64)	55(46-66)	53(46-65)
Age (years)	20-49	285（25.4）	487（38.6）	772（32.4）	54.638	<0.001
	50-79	839（74.6）	775（61.4）	1 614（67.6）
Race	White	817（72.7）	920（72.9）	1 737（72.8）	14.547	0.003
	Black	232（20.6）	237（18.8）	469（19.7）
	Other	75（6.7）	105（8.3）	180（7.5）
Marital status	Married	695（61.8）	776（61.5）	1 471（61.7）	2.531	0.089
	Not married	429（38.2）	486（38.5）	915（38.3）
Laterality	Left	572（50.9）	629（49.8）	1 201（50.3）	3.015	0.078
	Right	552（49.1）	633（50.2）	1 185（49.7）
Histologic grade	Ⅰ	34（3.0）	23（1.8）	57（2.4）	25.413	<0.001
	Ⅱ	209（18.5）	201（15.9）	410（17.1）
	Ⅲ	883（78.5）	1 038（82.3）	1 921（80.5）
AJCC stage	Ⅰ	595（52.9）	367（29.1）	962（40.3）	15.582	<0.001
	Ⅱ	471（41.9）	668（52.9）	1 139（47.7）
	Ⅲ	58（5.2）	227（18.0）	285（12.0）
Tumor diameter (cm)	≤2	661（58.8）	452（35.8）	1 113（46.6）	30.769	<0.001
	>2 & ≤5	425（37.8）	637（50.5）	1 062（44.5）
	>5	38（3.4）	173（13.7）	211（8.9）
Nodal status	0	875（77.8）	729（57.8）	1 604（67.2）	19.464	<0.001
	1-3	191（17.0）	349（27.6）	540（22.7）
	4-9	37（3.3）	106（8.4）	143（6.0）
	>9	21（1.9）	78（6.2）	99（4.1）
Radiation	Yes	1 124（100）	380（30.1）
	No	0	882（69.9）

Characteristics	Before matching（BCS+RT vs. Mastectomy）	After matching（BCS+RT vs. Mastectomy）
Age≥50 (years)	SMD=0.32（P<0.001）	SMD=0.05（P=0.21）
Tumor diameter≤2 cm	SMD=0.45（P<0.001）	SMD=0.03（P=0.67）
No lymph node metastasis	SMD=0.41（P<0.001）	SMD=0.02（P=0.83）
AJCC stage Ⅰ	SMD=0.51（P<0.001）	SMD=0.04（P=0.35）
Histologic grade Ⅰ+Ⅱ	SMD=0.12（P<0.001）	SMD=0.06（P=0.17）

Characteristics		BCSS			OS
Characteristics		HRs(95%CI)	χ² value	P value	HRs(95%CI)	χ² value	P value
Age(years)	20-49	1.098(0.92-1.243)	0.986	0.325	0.917(0.894-1.215)	1.054	0.618
Age(years)	50-79	1			1
Race	White	1			1
	Black	1.314(1.121-1.468)	4.763	0.029	1.295(1.097-1.474)	5.449	0.007
	Other	0.857(0.682-1.218)	1.674	0.381	0.916(0.753-1.187)	2.018	0.427
Marital status	Married	1			1
Marital status	Not married	1.361(1.172-1.624)	5.298	<0.001	1.357(1.286-1.687)	6.452	<0.001
Laterality	Left	1			1
Laterality	Right	0.937(0.788-1.146)	0.631	0.356	0.973(0.849-1.126)	0.831	0.653
Histologic grade	Ⅰ	0.207(0.076-0.631)	7.263	0.005	0.176(0.058-0.521)	9.527	0.003
	Ⅱ	0.706(0.535-0.876)	10.539	0.002	0.743(0.582-0.841)	12.246	0.002
	Ⅲ	1			1
AJCC stage	Ⅰ	0.305(0.243-0.382)	25.746	<0.001	0.339(0.264-0.479)	20.369	<0.001
	Ⅱ	1			1
	Ⅲ	3.49(3.103-4.528)	17.347	<0.001	3.504(3.107-4.325)	11.367	<0.001
Tumor diameter (cm)	≤2	1			1
	>2 & ≤5	2.968(2.405-3.367)	9.488	<0.001	2.591(2.253-3.207)	7.218	<0.001
	>5	7.946(6.435-9.825)	11.472	<0.001	7.189(5.944-8.892	10.375	<0.001
Nodal status	0	1			1
	1-3	3.109(2.348-3.673)	17.422	<0.001	2.591(2.327-3.246)	24.462	<0.001
	4-9	6.063(4.981-7.762)	9.871	<0.001	5.467(4.326-6.576)	13.225	<0.001
	>9	12.684(10.126-15.837)	12.026	<0.001	11.769(9.462-14.737)	8.773	<0.001
Type of surgery	BCS+RT	0.416(0.298-0.504)	5.437	<0.001	0.385(0.306-0.421)	7.468	<0.001
Type of surgery	Mastectomy	1		<0.001	1		<0.001

Characteristics		BCSS			OS
Characteristics		HR(95%CI)	χ² value	P value	HR(95%CI)	χ² value	P value
Race	White	1			1
	Black	1.036(0.854-1.273)	0.954	0.864	1.121(0.903-1.305)	1.125	0.627
	Other	0.874(0.593-1.175)	2.037	0.208	0.838(0.647-1.215)	0.693	0.251
Marital status	Married	1			1
Marital status	Not married	1.247(1.203-1.401)	13.261	0.014	1.312(1.136-1.509)	19.248	<0.001
Histologic grade	Ⅰ	0.347(0.125-1.046)	5.137	0.058	0.273(0.089-0.831)	8.934	0.024
	Ⅱ	0.904(0.670-1.127)	3.007	0.258	0.879(0.742-1.108)	2.763	0.257
	Ⅲ	1			1
AJCC stage	Ⅰ	1			1
	Ⅱ	0.716(0.489-1.128)	2.552	0.083	0.826(0.593-1.147)	1.931	0.194
	Ⅲ	0.824(0.591-1.206)	3.167	0.243	0.882(0.614-1.231)	0.678	0.307
Tumor diameter (cm)	≤2	1			1
	>2 & ≤5	1.617(1.179-2.153)	9.436	0.004	1.568(1.216-2.107)	13.772	0.003
	>5	3.285(2.367-4.621)	13.413	<0.001	3.011(2.146-3.979)	18.537	<0.001
Nodal status	0	1			1
	1-3	2.264(1.671-2.719)	26.248	<0.001	1.982(1.587-2.436)	29.553	<0.001
	4-9	4.419(2.738-6.874)	19.267	<0.001	3.735(2.583-5.889)	24.339	<0.001
	>9	8.018(5.327-12.997)	20.514	<0.001	7.864(5.149-11.837)	16762	<0.001
Type of surgery	BCS+RT	0.682(0.516-0.748)	8.537	<0.001	0.607(0.457-0.705)	7.651	<0.001
Type of surgery	Mastectomy	1			1

Characteristics	BCSS			OS
Characteristics	HR (95%CI）	χ² value	P value	HR (95%CI)	χ² value	P value
Age(years)
20-49	0.725(0.524-0.997)	0.841	0.038	0.806(0.569-1.117)	1.437	0.079
50-79	0.531(0.424-0.697)	37.953	<0.001	0.493(0.402-0.615)	36.218	<0.001
Histologic grade
Ⅰ	0.536(0.038-7.957)	1.256	0.687	0.543(0.036-8.107)	0.935	0.682
Ⅱ	0.584(0.329-0.985）	2.992	0.043	0.573(0.312-0.837)	5.436	0.015
Ⅲ	0.591(0.490-0.736)	17.638	<0.001	0.562(0.466-0.679)	19.379	<0.001
AJCC stage
Ⅰ	0.751(0.473-1.207)	1.357	0.225	0.749(0.508-1.114)	1.576	0.157
Ⅱ	0.607(0.483-0.809)	6.41	<0.001	0.562(0.463-0.714)	9.738	<0.001
Ⅲ	0.529(0.348-0.752)	10.379	<0.001	0.487(0.338-0.691)	8.337	<0.001
Tumor diameter(cm)
≤2	0.728(0.495-1.037)	2.965	0.071	0.702(0.516-0.937)	5.728	0.023
>2 & ≤5	0.571(0.484-0.775)	13.476	<0.001	0.531(0.418-0.660)	17.339	<0.001
>5	0.564(0.347-0.941)	5.816	0.031	0.554(0.328-0.898)	7.834	0.017
Nodal status
0	0.704(0.553-0.916）	5.437	0.012	0.614(0.488-0.801)	9.714	<0.001
1-3	0.579(0.406-0.757)	18.736	<0.001	0.533(0.374-0.719)	24.291	<0.001
4-9	0.587(0.346-0.982)	4.028	0.044	0.528(0.336-0.890)	6.229	0.015
>9	0.485(0.263-0.897)	9.517	0.021	0.457(0.251-0.844)	13.737	0.008