【medical-news】JAMA：乳腺癌近距离放疗应慎重使用
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Association Between Treatment With Brachytherapy vs Whole-Breast Irradiation and Subsequent Mastectomy, Complications, and Survival Among Older Women With Invasive Breast Cancer
JAMA：乳腺癌近距离放疗应慎重使用
http://jama.ama-assn.org/content/307/17/1827.short
Context Brachytherapy is a radiation treatment that uses an implanted radioactive source. In recent years, use of breast brachytherapy after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard whole-breast irradiation (WBI). Because results of long-term randomized trials will not be reported for years, detailed analysis of clinical outcomes in a nonrandomized setting is warranted.
近距离放射疗法是一种利用植入性放射源来进行放疗的手段。近些年中，在对早期乳腺癌进行肿瘤切除术后施行乳腺近距离放疗的案例已经有了大幅的增加，然而，将其与标准化全乳房照射（WBI）进行功效比较的随机化的试验数据仍然缺乏。
Objective To compare the likelihood of breast preservation, complications, and survival for brachytherapy vs WBI among a nationwide cohort of older women with breast cancer with fee-for-service Medicare.
美国德克萨斯大学MD Anderson癌症中心的Grace L. Smith, M.D., Ph.D., M.P.H.及其同事们开展了一项研究，旨在比较被诊断患有浸润性乳腺癌的医疗保险受益的老年病人中乳腺近距离放疗 VS WBI对乳房长期保全的可能性、并发症及存活率的影响。相关成果发表在JAMA最新一期在线版。
Design Retrospective population-based cohort study of 92 735 women aged 67 years or older with incident invasive breast cancer, diagnosed between 2003 and 2007 and followed up through 2008. After lumpectomy 6952 patients were treated with brachytherapy vs 85 783 with WBI.
这一基于人口的回顾性研究共纳入了9,2735名年龄在67岁或以上的罹患浸润性乳腺癌的妇女，她们是在2003至2007年间被诊断并一直随访至2008年。在肿块切除后，6952名患者接受了近距离放疗，另有 8,5783名患者接受了WBI。
Main Outcome Measures Cumulative incidence and adjusted risk of subsequent mastectomy (an indicator of failure to preserve the breast) and death were compared using the log-rank test and proportional hazards models. Odds of postoperative infectious and noninfectious complications within 1 year were compared using the χ2 test and logistic models. Cumulative incidences of long-term complications were compared using the log-rank test.
主要研究指标为后续手术（保乳失败）的累积发生率，校正后的危险比及死亡率，均通过时序检测和比例风险回归模型得到。此外，研究者还利用χ2检验和逻辑模型比较两组间1年内患者术后感染和非感染性并发症的比例，长期并发症的积累发生率则依靠时序检验得到。
Results Five-year incidence of subsequent mastectomy was higher in women treated with brachytherapy (3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001) and persisted after multivariate adjustment (hazard ratio [HR], 2.19; 95% CI, 1.84-2.61, P < .001). Brachytherapy was associated with more frequent infectious (16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88) and noninfectious (16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; adjusted OR, 2.03; 95% CI, 1.89-2.17) postoperative complications; and higher 5-year incidence of breast pain (14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%), fat necrosis (8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%), and rib fracture (4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; P ≤ .01 for all). Five-year overall survival was 87.66% (95% CI, 85.94%-89.18%) in patients treated with brachytherapy vs 87.04% (95% CI, 86.69%-87.39%) in patients treated with WBI (adjusted HR, 0.94; 95% CI, 0.84-1.05; P = .26).
研究人员发现，乳腺近距离放疗与随后的乳房切除术的较高风险有关，其5年累计发生率为(3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001)，多元校正后趋势仍保持一致(危害比 [HR], 2.19; 95% CI, 1.84-2.61, P < .001)。乳房近距离放疗还与较高的感染风险(16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88)及非感染性术后综合症(16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; 校正后OR值, 2.03; 95% CI, 1.89-2.17)有关；5年累计性乳房疼痛的发生率在接受近距离放疗的患者中比例也较高(14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%)；脂肪坏死发生率也更高(8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%)；肋骨骨折发生率较高(4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; 均P ≤ .01)。乳房近距离放疗组和WBI组5年总体生存率分别为 87.66% (95% CI, 85.94%-89.18%) VS 87.04% (95% CI, 86.69%-87.39%)(校正后 HR值, 0.94; 95% CI, 0.84-1.05; P = .26)。
Conclusion In a cohort of older women with breast cancer, treatment with brachytherapy compared with WBI was associated worse with long-term breast preservation and increased complications but no difference in survival.
由此研究者得出结论：在罹患浸润性乳腺癌并接受了肿块切除术的老年妇女中，与全乳房照射相比，近距离放射治疗与乳房长期保全可能性下降及并发症可能性的增加有关，但在总体存活率上则没有差别。
近距离放射疗法是一种利用植入性放射源来进行放疗的手段。近些年中，在对早期乳腺癌进行肿瘤切除术后施行乳腺近距离放疗的案例已经有了大幅的增加，然而，将其与标准化全乳房照射（WBI）进行功效比较的随机化的试验数据仍然缺乏。
美国德克萨斯大学MD Anderson癌症中心的Grace L. Smith, M.D., Ph.D., M.P.H.及其同事们开展了一项研究，旨在比较被诊断患有浸润性乳腺癌的医疗保险受益的老年病人中乳腺近距离放疗 VS WBI对乳房长期保全的可能性、并发症及存活率的影响。相关成果发表在JAMA最新一期在线版。
这一基于人口的回顾性研究共纳入了9,2735名年龄在67岁或以上的罹患浸润性乳腺癌的妇女，她们是在2003至2007年间被诊断并一直随访至2008年。在肿块切除后，6952名患者接受了近距离放疗，另有 8,5783名患者接受了WBI。
主要研究指标为后续手术（保乳失败）的累积发生率，校正后的危险比及死亡率，均通过时序检测和比例风险回归模型得到。此外，研究者还利用χ2检验和逻辑模型比较两组间1年内患者术后感染和非感染性并发症的比例，长期并发症的积累发生率则依靠时序检验得到。
研究人员发现，乳腺近距离放疗与随后的乳房切除术的较高风险有关，其5年累计发生率为(3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001)，多元校正后趋势仍保持一致(危害比 [HR], 2.19; 95% CI, 1.84-2.61, P < .001)。乳房近距离放疗还与较高的感染风险(16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88)及非感染性术后综合症(16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; 校正后OR值, 2.03; 95% CI, 1.89-2.17)有关；5年累计性乳房疼痛的发生率在接受近距离放疗的患者中比例也较高(14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%)；脂肪坏死发生率也更高(8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%)；肋骨骨折发生率较高(4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; 均P ≤ .01)。乳房近距离放疗组和WBI组5年总体生存率分别为 87.66% (95% CI, 85.94%-89.18%) VS 87.04% (95% CI, 86.69%-87.39%)(校正后 HR值, 0.94; 95% CI, 0.84-1.05; P = .26)。
由此研究者得出结论：在罹患浸润性乳腺癌并接受了肿块切除术的老年妇女中，与全乳房照射相比，近距离放射治疗与乳房长期保全可能性下降及并发症可能性的增加有关，但在总体存活率上则没有差别。
字数统计：1280
JAMA：乳腺癌近距离放疗应慎重使用
http://jama.ama-assn.org/content/307/17/1827.short
Context Brachytherapy is a radiation treatment that uses an implanted radioactive source. In recent years, use of breast brachytherapy after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard whole-breast irradiation (WBI). Because results of long-term randomized trials will not be reported for years, detailed analysis of clinical outcomes in a nonrandomized setting is warranted.
近距离放射疗法是一种利用植入性放射源来进行放疗的手段。近些年中，在对早期乳腺癌进行肿瘤切除术后施行乳腺近距离放疗的案例已经有了大幅的增加，然而，将其与标准化全乳房照射（WBI）进行功效比较的随机化的试验数据仍然缺乏。
Objective To compare the likelihood of breast preservation, complications, and survival for brachytherapy vs WBI among a nationwide cohort of older women with breast cancer with fee-for-service Medicare.
美国德克萨斯大学MD Anderson癌症中心的Grace L. Smith, M.D., Ph.D., M.P.H.及其同事们开展了一项研究，旨在比较被诊断患有浸润性乳腺癌的医疗保险受益的老年病人中乳腺近距离放疗 VS WBI对乳房长期保全的可能性、并发症及存活率的影响。相关成果发表在JAMA最新一期在线版。
Design Retrospective population-based cohort study of 92 735 women aged 67 years or older with incident invasive breast cancer, diagnosed between 2003 and 2007 and followed up through 2008. After lumpectomy 6952 patients were treated with brachytherapy vs 85 783 with WBI.
这一基于人口的回顾性研究共纳入了9,2735名年龄在67岁或以上的罹患浸润性乳腺癌的妇女，她们是在2003至2007年间被诊断并一直随访至2008年。在肿块切除后，6952名患者接受了近距离放疗，另有 8,5783名患者接受了WBI。
Main Outcome Measures Cumulative incidence and adjusted risk of subsequent mastectomy (an indicator of failure to preserve the breast) and death were compared using the log-rank test and proportional hazards models. Odds of postoperative infectious and noninfectious complications within 1 year were compared using the χ2 test and logistic models. Cumulative incidences of long-term complications were compared using the log-rank test.
主要研究指标为后续手术（保乳失败）的累积发生率，校正后的危险比及死亡率，均通过时序检测和比例风险回归模型得到。此外，研究者还利用χ2检验和逻辑模型比较两组间1年内患者术后感染和非感染性并发症的比例，长期并发症的积累发生率则依靠时序检验得到。
Results Five-year incidence of subsequent mastectomy was higher in women treated with brachytherapy (3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001) and persisted after multivariate adjustment (hazard ratio [HR], 2.19; 95% CI, 1.84-2.61, P < .001). Brachytherapy was associated with more frequent infectious (16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88) and noninfectious (16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; adjusted OR, 2.03; 95% CI, 1.89-2.17) postoperative complications; and higher 5-year incidence of breast pain (14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%), fat necrosis (8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%), and rib fracture (4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; P ≤ .01 for all). Five-year overall survival was 87.66% (95% CI, 85.94%-89.18%) in patients treated with brachytherapy vs 87.04% (95% CI, 86.69%-87.39%) in patients treated with WBI (adjusted HR, 0.94; 95% CI, 0.84-1.05; P = .26).
研究人员发现，乳腺近距离放疗与随后的乳房切除术的较高风险有关，其5年累计发生率为(3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001)，多元校正后趋势仍保持一致(危害比 [HR], 2.19; 95% CI, 1.84-2.61, P < .001)。乳房近距离放疗还与较高的感染风险(16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88)及非感染性术后综合症(16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; 校正后OR值, 2.03; 95% CI, 1.89-2.17)有关；5年累计性乳房疼痛的发生率在接受近距离放疗的患者中比例也较高(14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%)；脂肪坏死发生率也更高(8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%)；肋骨骨折发生率较高(4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; 均P ≤ .01)。乳房近距离放疗组和WBI组5年总体生存率分别为 87.66% (95% CI, 85.94%-89.18%) VS 87.04% (95% CI, 86.69%-87.39%)(校正后 HR值, 0.94; 95% CI, 0.84-1.05; P = .26)。
Conclusion In a cohort of older women with breast cancer, treatment with brachytherapy compared with WBI was associated worse with long-term breast preservation and increased complications but no difference in survival.
由此研究者得出结论：在罹患浸润性乳腺癌并接受了肿块切除术的老年妇女中，与全乳房照射相比，近距离放射治疗与乳房长期保全可能性下降及并发症可能性的增加有关，但在总体存活率上则没有差别。
近距离放射疗法是一种利用植入性放射源来进行放疗的手段。近些年中，在对早期乳腺癌进行肿瘤切除术后施行乳腺近距离放疗的案例已经有了大幅的增加，然而，将其与标准化全乳房照射（WBI）进行功效比较的随机化的试验数据仍然缺乏。
美国德克萨斯大学MD Anderson癌症中心的Grace L. Smith, M.D., Ph.D., M.P.H.及其同事们开展了一项研究，旨在比较被诊断患有浸润性乳腺癌的医疗保险受益的老年病人中乳腺近距离放疗 VS WBI对乳房长期保全的可能性、并发症及存活率的影响。相关成果发表在JAMA最新一期在线版。
这一基于人口的回顾性研究共纳入了9,2735名年龄在67岁或以上的罹患浸润性乳腺癌的妇女，她们是在2003至2007年间被诊断并一直随访至2008年。在肿块切除后，6952名患者接受了近距离放疗，另有 8,5783名患者接受了WBI。
主要研究指标为后续手术（保乳失败）的累积发生率，校正后的危险比及死亡率，均通过时序检测和比例风险回归模型得到。此外，研究者还利用χ2检验和逻辑模型比较两组间1年内患者术后感染和非感染性并发症的比例，长期并发症的积累发生率则依靠时序检验得到。
研究人员发现，乳腺近距离放疗与随后的乳房切除术的较高风险有关，其5年累计发生率为(3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001)，多元校正后趋势仍保持一致(危害比 [HR], 2.19; 95% CI, 1.84-2.61, P < .001)。乳房近距离放疗还与较高的感染风险(16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88)及非感染性术后综合症(16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; 校正后OR值, 2.03; 95% CI, 1.89-2.17)有关；5年累计性乳房疼痛的发生率在接受近距离放疗的患者中比例也较高(14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%)；脂肪坏死发生率也更高(8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%)；肋骨骨折发生率较高(4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; 均P ≤ .01)。乳房近距离放疗组和WBI组5年总体生存率分别为 87.66% (95% CI, 85.94%-89.18%) VS 87.04% (95% CI, 86.69%-87.39%)(校正后 HR值, 0.94; 95% CI, 0.84-1.05; P = .26)。
由此研究者得出结论：在罹患浸润性乳腺癌并接受了肿块切除术的老年妇女中，与全乳房照射相比，近距离放射治疗与乳房长期保全可能性下降及并发症可能性的增加有关，但在总体存活率上则没有差别。
字数统计：1280
