Supplementary materials: Breast-conserving surgery versus mastectomy for older women with triple-negative breast cancer: population-based study

<b>These are peer-reviewed supplementary materials for the article '</b><b>Breast-conserving surgery versus </b><b>mastectomy for older women with </b><b>triple-negative breast cancer: </b><b>population-based study</b><b>' published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplementary figure 1</b><b>Supplementary figure 2</b><b>Supplementary figure 3</b><b>Supplementary figure 4</b><b>Supplementary Table S1: </b>Cohort inclusion and exclusion criteria<b>Supplementary Table S2:</b><b> </b>Codes used to identity radiation, mastectomy, breast conserving surgery<b>Supplementary Table S3: </b>IPTW cox proportional hazards model predicting all-cause mortality<b>Supplementary Table S4: </b>IPTW Fine-Gray Subdistribution hazard model for breast cancer death<b>Supplementary Table S5a: </b>Multivariate Cox proportional hazards model predicting all-cause mortality after excluding those who survived for only one month<b>Supplementary Table S5b: </b>Pairwise comparison - Multivariate Cox proportional hazards model predicting all-cause mortality after excluding those who survived for a month or less<b>Supplementary Table S6a: </b>Fine-Gray Subdistribution hazard model for breast cancer death after excluding those who survived for a month or less<b>Supplementary Table S6b: </b>Pairwise comparison - Fine-Gray Subdistribution hazard model for breast cancer death after excluding those who survived for a month or less<b>Supplementary Table S7a: </b>Continuous age and tumor size broke further - Multivariate Cox proportional hazards model predicting all-cause mortality<b>Supplementary Table S7b: </b>Pairwise comparison - Continuous age and tumor size broke further - Multivariate Cox proportional hazards model predicting all-cause mortality<b>Supplementary Table S8a: </b>Continuous age and tumor size broke further - Fine-Gray Subdistribution hazard model for breast cancer death<b>Supplementary Table S8b: </b>Pairwise comparison - Continuous age and tumor size broke further - Fine-Gray Subdistribution hazard model for breast cancer deathSupplementary Table S9: Chemotherapy receipt by treatment<b>Supplementary</b><b> Table S10a: </b>Multivariate Cox proportional hazards model predicting all-cause mortality including chemotherapy adjustment<b>Supplementary</b><b> Table S10b: </b>Pairwise Comparison - multivariate Cox proportional hazards model predicting all-cause mortality including chemotherapy adjustment<b>Supplementary</b><b> Table S11a: </b>Fine-Gray Subdistribution hazard model for breast cancer death including chemotherapy adjustment<b>Supplementary</b><b> Table S11b: </b>Pairwise comparison - Fine-Gray Subdistribution hazard model for breast cancer death including chemotherapy adjustment<b>Supplementary</b><b> Table S12: </b>Factors associated with receiving radiotherapy after breast conserving surgery<b>Purpose:</b> To assess whether the poor prognosis of triple-negative breast cancer (TNBC) necessitates a more aggressive surgical approach. <b>Methods:</b> We examined the association of: breast-conserving surgery (BCS); BCS plus radiotherapy; mastectomy; and mastectomy plus radiotherapy with overall and breast cancer-specific survival of stage I–III TNBC patients aged 66 years and older. We used unweighted and inverse probability of treatment weighted Cox proportional hazards regression and the Fine and Gray sub-distribution model. <b>Results: </b>Among 4333 women, individuals who were selected for BCS, mastectomy or mastectomy plus radiotherapy had lower adjusted overall and breast cancer-specific survival compared with women who had BCS plus radiotherapy. <b>Conclusion:</b> In this population-based study, women with TNBC treated with BCS plus radiotherapy have a better prognosis than those treated with BCS, mastectomy or mastectomy plus radiotherapy. Given the poor prognosis of TNBC and selection bias inherent in observational studies, these findings should be confirmed in further studies such as randomized clinical trials.<br>

本文件为发表于《比较效果研究杂志》（*Journal of Comparative Effectiveness Research*）的论文《老年三阴性乳腺癌（triple-negative breast cancer, TNBC）患者保乳术与乳房切除术对比：基于人群的研究》的同行评议补充材料。
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补充表S1：队列纳入与排除标准
补充表S2：用于识别放疗、乳房切除术、保乳术（breast-conserving surgery, BCS）的编码
补充表S3：预测全因死亡率的逆概率治疗加权（Inverse Probability of Treatment Weighted, IPTW）Cox比例风险模型
补充表S4：预测乳腺癌死亡的IPTW Fine-Gray亚分布风险模型
补充表S5a：排除仅生存1个月患者后预测全因死亡率的多变量Cox比例风险模型
补充表S5b：两两比较——排除生存1个月及以内患者后预测全因死亡率的多变量Cox比例风险模型
补充表S6a：排除生存1个月及以内患者后用于乳腺癌死亡预测的Fine-Gray亚分布风险模型
补充表S6b：两两比较——排除生存1个月及以内患者后用于乳腺癌死亡预测的Fine-Gray亚分布风险模型
补充表S7a：进一步按连续年龄与肿瘤大小分层——预测全因死亡率的多变量Cox比例风险模型
补充表S7b：两两比较——进一步按连续年龄与肿瘤大小分层——预测全因死亡率的多变量Cox比例风险模型
补充表S8a：进一步按连续年龄与肿瘤大小分层——乳腺癌死亡预测的Fine-Gray亚分布风险模型
补充表S8b：两两比较——进一步按连续年龄与肿瘤大小分层——乳腺癌死亡预测的Fine-Gray亚分布风险模型
补充表S9：不同治疗方案的化疗接受情况
补充表S10a：纳入化疗校正因素的全因死亡率预测多变量Cox比例风险模型
补充表S10b：两两比较——纳入化疗校正因素的全因死亡率预测多变量Cox比例风险模型
补充表S11a：纳入化疗校正因素的乳腺癌死亡预测Fine-Gray亚分布风险模型
补充表S11b：两两比较——纳入化疗校正因素的乳腺癌死亡预测Fine-Gray亚分布风险模型
补充表S12：保乳术后放疗接受率的影响因素
**研究目的**：评估三阴性乳腺癌（TNBC）的不良预后是否需要更激进的手术治疗方案。
**研究方法**：本研究纳入66岁及以上的I~III期三阴性乳腺癌患者，分析保乳术（BCS）、保乳术联合放疗、乳房切除术、乳房切除术联合放疗四种治疗方案与患者总生存期及乳腺癌特异性生存期的关联。研究采用未加权及IPTW Cox比例风险回归模型，以及Fine-Gray亚分布风险模型进行分析。
**研究结果**：在4333名女性患者中，接受保乳术、乳房切除术或乳房切除术联合放疗的患者，其校正后的总生存期及乳腺癌特异性生存期均低于接受保乳术联合放疗的患者。
**研究结论**：本项基于人群的研究显示，接受保乳术联合放疗的三阴性乳腺癌患者预后优于接受保乳术、乳房切除术或乳房切除术联合放疗的患者。鉴于三阴性乳腺癌的不良预后及观察性研究固有的选择偏倚，本研究结论需在后续随机临床试验等研究中进一步验证。