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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2015, Vol. 09 ›› Issue (03) : 168 -172. doi: 10.3877/cma.j.issn.1674-0807.2015.03.003

论著

乳腺癌新辅助化疗后腋窝淋巴结1 ～3 枚转移的患者改良根治术后放射治疗的疗效分析
铁剑1,†(), 张丝媛1   
  1. 1.100142 北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科恶性肿瘤发病机制及转化研究教育部重点实验室
  • 收稿日期:2015-04-23 出版日期:2015-06-01
  • 通信作者: 铁剑

Curative effect analysis of radiotherapy after modified radical mastectomy for breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy

Jian Tie1,†(), Siyuan Zhang1   

  1. 1.Key Laboratory of Carcinogenesis and Translational Research,Department of Radiation Oncology,Beijing Cancer Hospital & Institute,Peking University, Beijing 100142,China
  • Received:2015-04-23 Published:2015-06-01
  • Corresponding author: Jian Tie
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铁剑, 张丝媛. 乳腺癌新辅助化疗后腋窝淋巴结1 ～3 枚转移的患者改良根治术后放射治疗的疗效分析[J/OL]. 中华乳腺病杂志(电子版), 2015, 09(03): 168-172.

Jian Tie, Siyuan Zhang. Curative effect analysis of radiotherapy after modified radical mastectomy for breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2015, 09(03): 168-172.

目的

探讨术后放射治疗(简称放疗)在新辅助化疗后腋窝淋巴结转移数1 ～3 枚的乳腺癌改良根治术后患者中的作用。

方法

回顾性分析136 例2002 年1 月至2008 年9 月于北京大学肿瘤医院接受了新辅助化疗的T1 或T2 期、腋窝淋巴结转移数1 ～3 枚的改良根治术后乳腺癌患者的临床资料。 按患者接受术后放疗与否分为术后放疗组和未放疗组。 采用Pearson χ2 检验分析患者临床病理特征在放疗与未放疗组间分布的差异,采用Kaplan-Meier 生存分析法比较两组在局部区域复发与生存方面的差异,并采用Cox 回归分析进行多因素分析。

结果

136 例患者中,接受术后放疗者占38.2%(52/136),未放疗者占61.8%(84/136)。 两组患者在年龄、原发灶临床分期、淋巴结活组织检查、ER 状态、HER-2状态以及化疗后原发灶是否达到pCR 等方面差异无统计学意义(χ2=0.016、5.790、0.476、0.001、2.612、0.982,P 均＞0.050)。 中位随访时间为88.9(16.5 ～148.1)个月。 放疗组与未放疗组10 年无局部区域复发生存率(LRRFS)分别为97.9%和83.5%,差异有统计学意义(u=2.80,P＜0.01);10 年无远处转移生存率(DDFS)分别为61.2%和84.0%(u=1.73,P＞0.050),10 年无瘤生存率(DFS)分别为61.2%和76.8%(u=1.14,P＞0.050),10 年总生存率(OS)分别为87.7%和83.6%(u=0.45,P＞0.050), 差异均无统计学意义。 多因素分析显示,术后放疗是LRRFS 的独立预后因素,未放疗患者局部区域复发风险明显增高(HR=32.8,95%CI:2.6 ～408.0,P=0.007),但术后放疗不是DDFS、DFS 及OS 的预后因素。

结论

术后放疗可以明显减少新辅助化疗后腋窝淋巴结转移数1 ～3 枚的乳腺癌改良根治术后患者的局部区域复发,但对DDFS、DFS 及OS 无明显影响。

关键词: 乳腺肿瘤, 淋巴转移, 放射疗法, 化学疗法, 辅助

Objective

To investigate the effects of radiotherapy after modified radical mastectomy in breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy.

Methods

We retrospectively analyzed the clinical data of 136 stage T1-2 breast cancer patients with 1-3 positive axillary lymph nodes, who underwent neoadjuvant chemotherapy followed by modified radical mastectomy in Beijing Cancer Hospital & Institute from January 2002 to September 2008.They were divided into radiotherapy group and nonradiotherapy group.Pearson χ2 test was used to analyze the difference in clinicopathological characteristics between two groups, Kaplan-Meier method was used to analyze the differences in local-regional recurrence and survival rate, and Cox regression was used for multivariate analysis.

Results

In 136 patients, 52 patients received postoperative radiotherapy (38.2%, 52/136), and 84 patients received no radiotherapy (61.8%,84/136).There were no significant differences between two groups in age, clinical stage of primary tumor,lymph node biopsy method, ER status, HER-2 status, and whether to achieve pCR of the primary tumor after chemotherapy(χ2= 0.016,5.790,0.476,0.001,2.612,0.982, all P values ＞0.050).All patients were followed up for median 88.9 months(16.5-148.1 months).A significant difference was found in 10-year localregional recurrent-free survival (LRRFS)between radiotherapy group and non-radiotherapy group (97.9% vs 83.5%,u=2.80, P＜0.01), but not in 10-year distant metastasis-free survival (DDFS)(61.2% vs 84.0%,u=1.73, P＞0.050), 10-year disease-free survival (DFS)(61.2% vs 76.8%, u=1.14, P＞0.050), and 10-year overall survival (OS) (87.7% vs 83.6%,u=0.45, P＞0.050).Multivariate analysis showed that postoperative radiotherapy was an independent prognostic factor of LRRFS and the risk of local recurrence significantly increased in the patients undergoing radiotherapy (HR=32.8,95%CI:2.6-408.0, P=0.007).The postoperative radiotherapy was not a prognostic factor of DDFS, DFS and OS.

Conclusion

For the breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy, radiotherapy after modified radical mastectomy can significantly reduce local-regional recurrence, but without obvious effects on DDFS, DFS and OS.

Key words: Breast neoplasms, Lymphatic metastasis, Radiotherapy, Chemotherapy, adjuvant
表1 多因素分析各变量赋值表
变量 变量的分类及赋值
年龄(岁) ≤40岁=1;＞40岁=2
临床分期 T1=1;T2=2
淋巴结活检 前哨淋巴结活检=1;细针穿刺=2
ER -=0;+=1
HER-2 -=0;+=1;不确定=2
原发灶pCR 否=0;是=1
淋巴结转移 1枚=1;2枚=2;3枚=3
放射治疗 否=0;是=1
表2 乳腺癌患者临床病理特征在放疗与未放疗组中的分布差异
临床病理特征 例数 未放疗组 放疗组 χ2值 P值
例数 构成比(%) 例数 构成比(%)
年龄(岁) 0.016 0.898
≤40 28 17(60.7) 11(39.3)
＞40 108 67(62.0) 41(38.0)
临床分期 5.790 0.055
T1 34 25(73.5) 9(26.5)
T2 98 55(56.1) 43(43.9)
Tx 4 4(100.0) 0(0.0)
淋巴结活检 0.476 0.490
SLNB 60 39(65.0) 21(35.0)
细针穿刺 76 45(59.2) 31(40.8)
ER 0.001 0.973
- 39 24(61.5) 15(38.5)
+ 97 60(61.9) 37(38.1)
HER-2 2.612 0.271
- 87 55(63.2) 32(36.8)
+ 33 22(66.7) 11(33.3)
不确定 16 7(43.8) 9(56.3)
原发灶pCR 0.982 0.322
否 115 69(60.0) 46(40.0)
是 21 15(71.4) 6(28.6)
图1 放疗与未放疗组乳腺癌患者的生存曲线比较 注:a 图所示无局部区域复发生存曲线,χ2=5.226,P=0.022; b 图所示无远处转移生存曲线,χ2=3.061,P=0.080; c 图所示无瘤生存曲线,χ2=1.004,P=0.316; d 图所示总生存曲线,χ2=0.226,P=0.634
表3 放疗与未放疗组乳腺癌患者的10 年生存率比较
分组 10年生存率
LRRFS DDFS DFS OS
放疗组 97.9% 61.2% 61.2% 87.7%
未放疗组 83.5% 84.0% 76.8% 83.6%
u值 2.80 1.73 1.14 0.45
P值 ＜0.010 ＞0.050 ＞0.050 ＞0.050
表4 乳腺癌患者生存率的多因素分析结果
生存率 B值 HR 95%CI P值
放疗 未放疗
无局部区域复发生存率 3.491 1.0 32.8 2.6～408.0 0.007
无远处转移生存率 -0.420 1.0 0.7 0.3～1.6 0.361
无瘤生存率 -0.039 1.0 1.0 0.4～2.3 0.929
总生存率 0.328 1.0 1.4 0.4～5.3 0.631
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