基于逆概率加权法的早期三阴性乳腺癌不同治疗方案的疗效评价

doi:10.6040/j.issn.1671-7554.0.2021.0254

摘要/Abstract

摘要： 目的基于逆概率加权法(IPTW)评价保乳术联合术后放疗和乳房切除术治疗早期三阴性乳腺癌患者的疗效。方法基于美国SEER数据库,收集2010至2015年诊断为T1-2N0M0期三阴性乳腺癌患者相关资料,通过广义提升模型(GBM)估计倾向指数计算逆概率权重,加权均衡组间协变量后分析两种局部治疗方式对早期三阴性乳腺癌患者生存率的影响。结果 IPTW后,组间协变量达到完全均衡,log-rank检验结果表明,保乳术联合术后放疗组的总生存率(OS)高于乳房切除术组(P<0.001);多因素Cox回归分析结果显示,保乳术联合术后放疗组与乳房切除术组相比预后更好(HR=0.74,95%CI=0.65~0.84, P<0.001)。结论对T1-2N0M0期三阴性乳腺癌患者,保乳术联合术后放疗的疗效优于乳房切除术。

关键词: T1-2N0M0期三阴性乳腺癌, 逆概率加权法, 保乳术联合术后放疗, 乳房切除术, 疗效评价

Abstract: Objective To evaluate the efficacy of breast conserving surgery with postoperative radiotherapy and mastectomy for patients with early triple negative breast cancer based on inverse probability of treatment weighting(IPTW)method. Methods We extracted the data related to patients diagnosed with T1-2N0M0 triple negative breast cancer from the SEER database during 2010 and 2015, calculated the inverse probability weights by estimating the propensity index through the generalized boosted model(GBM), and analyzed the effects of two local treatment modalities on the survival rate of patients with early triple negative breast cancer after weighting the balanced intergroup covariates. Results After IPTW, the covariates between groups reached complete equilibrium, and log-rank test showed that the overall survival(OS)was better in the breast conserving with postoperative radiotherapy group than in the mastectomy group(P<0.001). The multifactorial Cox regression analysis showed that the breast conserving surgery with postoperative radiotherapy remained to be prognostic beneficial compared to mastectomy(HR=0.74, 95%CI=0.65-0.84, P<0.001). Conclusion Breast conserving surgery with postoperative radiotherapy is more effective than mastectomy in patients with T1-2N0M0 triple negative breast cancer.

Key words: T1-2N0M0 triple negative breast cancer, Inverse probability of treatment weighting method, Breast conserving surgery with postoperative radiotherapy, Mastectomy, Efficiency evaluation

中图分类号:

R181

王喆,刘玉洁,毛倩,管佩霞,包绮晗,李承圣,乔晓伟,潘庆忠,王素珍. 基于逆概率加权法的早期三阴性乳腺癌不同治疗方案的疗效评价[J]. 山东大学学报 (医学版), 2021, 59(8): 113-118.

WANG Zhe, LIU Yujie, MAO Qian, GUAN Peixia, BAO Qihan, LI Chengsheng, QIAO Xiaowei, PAN Qingzhong, WANG Suzhen. Evaluation of the efficacy of different regimens for early triple negative breast cancer based on the inverse probability of treatment weighting method[J]. Journal of Shandong University (Health Sciences), 2021, 59(8): 113-118.

参考文献

[1] 徐金发, 蔡清, 章秀芳, 等. 三阴乳腺癌术后含铂方案辅助化疗的疗效观察[J]. 中华肿瘤防治杂志, 2020, 27(S1): 34-36.
[2] 陈琳, 罗斌. 三阴性乳腺癌亚分型研究进展[J]. 中华肿瘤防治杂志, 2020, 27(20): 1683-1690. CHEN Lin, LUO Bin. Progress in subtyping triple-negative breast cancer [J]. Chinese Journal of Cancer Prevention and Treatment, 2020, 27(20): 1683-1690.
[3] 刘雪, 李雅全, 慕逢春, 等. 三阴型乳腺癌分子分型的新进展[J]. 临床与实验病理学杂志, 2020, 36(3): 316-319.
[4] 杨海林, 徐浩, 郑伦辉, 等. 三阴性乳腺癌预后相关因子的研究进展[J]. 中华乳腺病杂志(电子版), 2019, 13(3): 187-190.
[5] Heitz F, Harter P, Lueck HJ, et al. Triple-negative and HER2-overexpressing breast cancers exhibit an elevated risk and an earlier occurrence of cerebral metastases [J]. European Journal of Cancer, 2009, 45(16): 2792-2798.
[6] 韩丽飞, 张亚男, 胡浩霖, 等. 三阴性乳腺癌发生机制的信号传导通路[J]. 中华乳腺病杂志(电子版), 2019, 13(2): 115-117.
[7] 曹晓珊, 丛斌斌. 精准医学时代三阴性乳腺癌治疗的研究进展[J]. 中国癌症杂志, 2019, 29(12): 971-976. CAO Xiaoshan, CONG Binbin. The progress of treatment for triple-negative breast cancer in the era of precision medicine [J]. China Oncology, 2019, 29(12): 971-976.
[8] 孙莉, 赵毅. 三阴性乳腺癌治疗的研究进展[J]. 现代肿瘤医学, 2019, 27(13): 2420-2424. SUN Li, ZHAO Yi. Research progress in the treatment of triple negative breast cancer [J]. Modern Oncology, 2019, 27(13): 2420-2424.
[9] 岳雁鸿, 王瑶, 曾燕. 保乳术、改良根治术和改良根治术联合放疗治疗三阴性乳腺癌术后局部复发情况比较[J]. 中华普外科手术学杂志(电子版), 2019, 13(2): 177-179. YUE Yanhong, WANG Yao, ZENG Yan. Comparison of local recurrence for triple negative breast cancer after breast conserving therapy, modified radical mastectomy and breast conserving therapy combined with radiation therapy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(2): 177-179.
[10] Abdulkarim BS, Cuartero J, Hanson J, et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy [J]. J Clin Oncol, 2011, 29(21): 2852-2858.
[11] Zumsteg ZS, Morrow M, Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer [J]. Ann Surg Oncol, 2013, 20(11): 3469-3476.
[12] Wang X, Xu Y, Guo S, et al. T1-2N1M0 triple-negative breast cancer patients from the SEER database showed potential benefit from post-mastectomy radiotherapy [J]. Oncol Lett, 2020, 19(1): 735-744.
[13] 郭威. 基于统计学习的逆概率加权方法研究及其在医学中的应用[D]. 上海:中国人民解放军海军军医大学, 2018.
[14] Zhu Y, Coffman DL, Ghosh D. A boosting algorithm for estimating generalized propensity scores with continuous treatments [J]. J Causal Inference, 2015, 3(1): 25-40.
[15] Harder VS, Stuart EA, Anthony JC. Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research [J]. Psychol Methods, 2010, 15(3): 234-249.
[16] Fullerton B, Pöhlmann B, Krohn R, et al. The comparison of matching methods using different measures of balance: benefits and risks exemplified within a study to evaluate the effects of German disease management programs on long-term outcomes of patients with type 2 diabetes [J]. Health Serv Res, 2016, 51(5): 1960-1980.
[17] 杨伟, 唐进法, 易丹辉, 等. GBM倾向评分加权法用于因果推断的研究[J]. 世界科学技术-中医药现代化, 2017, 19(9): 1462-1472.
[18] McCaffrey DF, Griffin BA, Almirall D, et al. A tutorial on propensity score estimation for multiple treatments using generalized boosted models [J]. Stat Med, 2013, 32(19): 3388-3414.
[19] 田野, 马洁, 黄璐, 等. 双稳健半参模型法评价CAF和TAC化疗方案治疗乳腺癌疗效的回顾性分析[J]. 中国卫生统计, 2019, 36(1): 57-61. TIAN Ye, MA Jie, HUANG Lu, et al. Retrospective analysis on the efficacy of CAF and TAC chemotherapy in the treatment of breast cancer with double-robust semiparametric model method [J]. Chinese Journal of Health Statistics, 2019, 36(1): 57-61.
[20] 胡红林. 倾向评分法在医学研究中的应用和分析[D]. 武汉:华中科技大学, 2009.
[21] Austin PC. Variance estimation when using inverse probability of treatment weighting(IPTW)with survival analysis[J]. Stat Med, 2016, 35(30): 5642-5655.
[22] Bang H, Robins JM. Doubly robust estimation in missing data and causal inference models [J]. Biometrics, 2005, 61(4): 962-973.
[23] Lunceford JK, Davidian M. Stratification and weighting via the propensity score in estimation of causal treatment effects: a comparative study [J]. Stat Med, 2004, 23(19): 2937-2960.
[24] Wang SE, Sun YD, Zhao SJ, et al. Breast conserving surgery(BCS)with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients Running title: BCS had better prognosis than mastectomy for early TNBC patients [J]. Math Biosci Eng, 2019, 17(1): 92-104.
[25] van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study [J]. Lancet Oncol, 2016, 17(8): 1158-1170.
[26] 吕文芝, 丁波泥, 钱立元, 等. 保留乳房手术对比乳房根治术治疗三阴性乳腺癌疗效的Meta分析[J].中华乳腺病杂志(电子版), 2018, 12(5):276-281.
[27] Li H, Chen Y, Wang X, et al. T1-2N0M0 triple-negative breast cancer treated with breast-conserving therapy has better survival compared to mastectomy: a SEER population-based retrospective analysis [J]. Clin Breast Cancer, 2019, 19(6): e669-e682.
[28] 李焕. 分析保乳术后放疗、全乳切除术及全乳切除术后放疗对T1-2N0M0期三阴性乳腺癌的生存影响[D].广州:南方医科大学, 2020.

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