手术切除联合放疗降低转移性乳腺癌患者放射性皮炎风险尚无生存获益:一项回顾性队列研究OA

Objective The role of local interventions(surgery/radiotherapy)targeting the primary tumor in improving survival among patients with metastatic breast cancer(MBC)remains controversial.This retrospective cohort study compared two local treatment modalities—surgical resection combined with radiotherapy(S+R)versus radiotherapy alone(R)—in terms of toxicities and prognosis in treatment-naive MBC patients,to evaluate the survival benefit and safety profile of these approaches for primary tumor management in MBC.Methods Using a retrospective cohort design,we analyzed 89 de novo MBC patients treated at Department of Oncology,Affiliated Tumor Hospital of Guizhou Medical University,between 2010 and 2025(42 cases in the R group and 47 cases in the S+R group).Propensity score matching(PSM)with a caliper value of 0.2 was employed to balance baseline characteristics,yielding 62 matched patients(31 per group).The primary endpoints were overall survival(OS)and progression-free survival(PFS).Secondary endpoints included treatment-related adverse events(toxicity),local control(LC),and time to disease progression(TTP).Statistical analyses were performed to evaluate survival outcomes(OS,PFS,TTP)and toxicity indicators(radiation-induced skin fibrosis,radiation dermatitis,and ipsilateral limb lymphedema).Results Baseline characteristics were well balanced after matching(all P>0.05).The median follow-up was 56.2 months.No significant differences were observed between the S+R and R groups in median OS(55.4 vs 56.2 month,P=0.738),PFS(49.2 vs 37.0 months,P=0.959),or TTP(49.2 vs 37.5 months,P=0.808).No local recurrence occurred in either group(LC:100%vs 100%).Univariate and multivariate Cox regression analyses identified the triple-negative subtype as an independent risk factor for OS(HR=15.451,95%CI:1.253 to 190.579,P=0.033),and cN stage as an independent risk factor for PFS(HR=1.489,95%CI:1.006 to 2.202,P=0.046).For safety outcomes,compared with R,S+R yielded a significantly lower rate of grade 3 dermatitis(0 vs 12.9%,P=0.001),with comparable rates of fibrosis(3.23%vs 9.68%)and lymphedema of the affected limb(12.90%vs 6.45%)(both P>0.05).Conclusion Compared with R,S+R does not significantly improve survival outcomes in MBC patients,but it is associated with lower risk for radiation dermatitis.Triple-negative subtype and cN stage are identified as important adverse prognostic factors in MBC.