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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 134 -140. doi: 10.3877/cma.j.issn.1674-0807.2020.03.002

所属专题： 文献；

论著

免除乳房假体区域放射治疗对乳腺癌术后一期假体重建并发症及复发、转移的影响
李兴刚1, 张晔2, 冉凤伟2, 杜俊泽2, 钟玲2, 崔翔2, 张毅2, 姜军2, 范林军2,†()   
  1. 1. 644000　四川省宜宾市第三人民医院肝胆胰乳甲外科
    2. 400038　重庆，陆军军医大学第一附属医院乳腺甲状腺外科
  • 收稿日期:2020-02-20 出版日期:2020-06-01
  • 通信作者: 范林军

Effect of exempting radiotherapy in implant area on complications, recurrence and metastasis of breast cancer patients undergoing primary breast reconstruction

Xinggang Li1, Ye Zhang2, Fengwei Ran2, Junze Du2, Ling Zhong2, Xiang Cui2, Yi Zhang2, Jun Jiang2, Linjun Fan2,†()   

  1. 1. Department of Hepatopancreatobiliary, Breast and Thyroid Surgery, Third People’s Hospital of Yibin, Yibin 644000, Sichuan Province, China
    2. Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  • Received:2020-02-20 Published:2020-06-01
  • Corresponding author: Linjun Fan
  • About author:
    Corresponding author: Fan Linjun, Email:
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李兴刚, 张晔, 冉凤伟, 杜俊泽, 钟玲, 崔翔, 张毅, 姜军, 范林军. 免除乳房假体区域放射治疗对乳腺癌术后一期假体重建并发症及复发、转移的影响[J]. 中华乳腺病杂志(电子版), 2020, 14(03): 134-140.

Xinggang Li, Ye Zhang, Fengwei Ran, Junze Du, Ling Zhong, Xiang Cui, Yi Zhang, Jun Jiang, Linjun Fan. Effect of exempting radiotherapy in implant area on complications, recurrence and metastasis of breast cancer patients undergoing primary breast reconstruction[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(03): 134-140.

目的

探讨乳腺癌术后一期假体重建患者免除乳房假体区域放射治疗对并发症及复发、转移的影响。

方法

依据纳入、排除标准，选取2012年1月至2014年12月在陆军军医大学第一附属医院乳腺甲状腺外科确诊为乳腺癌，且行根治性切除加假体植入一期乳房重建术后放射治疗的95例患者进行回顾性研究。所有患者中，接受乳房假体区域加淋巴结引流区域放射治疗者56例(对照组)，免除乳房假体区域放射治疗而仅接受淋巴结引流区域放射治疗者39例(试验组)。每例患者经过5年以上的随访。对比分析2组患者放射治疗相关并发症(放射性皮肤损伤、放射性肺炎、包膜挛缩和假体取出)，以及肿瘤局部复发和远处转移的情况。放射治疗相关并发症发生率、肿瘤局部复发率及远处转移率的比较，采用χ2检验或Fisher确切概率检验。

结果

对照组56例患者中，发生5例(8.9%)放射性皮肤损伤，2例(3.6%)放射性肺炎，5例(8.9%)放射治疗引起的包膜挛缩(Ⅱ级和Ⅲ级各2例，Ⅳ级1例)，共导致2例(3.6%)假体取出，而试验组39例患者中，只发生1例(2.6%)放射性皮肤损伤；2组相比，放射性皮肤损伤、放射性肺炎、放射治疗引起的包膜挛缩和假体取出发生率的差异均无统计学意义(P＝0.395、0.511、0.076、0.511)。对照组共有12例(21.4%，12/56)患者发生放射治疗相关并发症，试验组仅1例(2.6%，1/39)患者发生放射治疗相关并发症，2组相比，差异有统计学意义(χ2＝6.926，P＝0.008)。中位随访66个月(范围：60～81个月)，对照组发生局部复发4例(7.1%，4/56)和远处转移5例(8.9%，5/56)，试验组局部复发和远处转移均为3例(7.7%，3/39)，2组比较，差异均无统计学意义(P＝0.999、0.999)。

结论

对于接受乳腺癌根治性切除术后一期假体重建的患者，免除乳腺假体区域放射治疗不影响其疗效，同时可以减少放射治疗相关并发症，改善患者术后生活质量。

关键词: 乳腺肿瘤, 放射肿瘤学, 手术后并发症, 肿瘤复发，局部, 肿瘤转移, 无病生存
Objective

To explore the effect of exempting radiotherapy in implant area on the complications, recurrence and metastasis of patients undergoing primary breast reconstruction after breast cancer surgery.

Methods

A total of 95 patients with breast cancer who underwent radiotherapy after mastectomy and immediate implant breast reconstruction in the Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University from January 2012 to December 2014 were enrolled into a retrospective study according to the inclusion and exclusion criteria. Fifty-six patients received radiotherapy in implant area and lymph node drainage area (control group) and 39 patients received radiotherapy only in lymph node drainage area (experimental group). All patients were followed up for over five years. The radiotherapy-related complications (radiation skin injury, radiation pneumonitis, capsule contracture and implant removal), local recurrence and distant metastasis of breast cancer were compared between two groups. The incidences of radiotherapy-related complications, local recurrence and distant metastasis were compared using the χ2 test or Fisher’s exact test between two groups.

Results

In the 56 patients of the control group, 5 cases(8.9%) had radiation skin injury, 2 (3.6%) radiation pneumonia, and 5 (8.9%) capsular contracture caused by radiotherapy (2 in grade Ⅱ, 2 in grade Ⅲ and 1 in grade Ⅳ), resulting implant removal in 2 cases(3.6%). Only one case (2.6%) had radiation skin injury in the experimental group. There were no significant differences in the incidences of radiation skin damage (P=0.395), radiation pneumonia (P=0.511), radiation-induced capsular contractures (P=0.076) and implant removal (P=0.511) between two groups. Twelve patients (21.4%, 12/56)in the control group and only one patient(2.6%, 1/39) in the experimental group had radiotherapy-related complications, indicating a significant difference between two groups (χ2=6.926, P=0.008). All patients were followed up for 60-81 months (median 66 months). Four cases (7.1%, 4/56) had local recurrence and 5 cases (8.9%, 5/56) had distant metastasis in the control group. Three cases(7.7%, 3/39) had local recurrence and 3 cases(7.7%, 3/39) had distant metastasis in the experimental group. There was no significant difference in the incidences of local recurrence (P=0.999) and distant metastasis (P=0.999) between two groups.

Conclusion

For patients undergoing primary implant breast reconstruction after mastectomy, exempting radiotherapy in implant area can reduce the incidence of radiation-related complications and improve the quality of life after surgery, without affecting efficacy.

Key words: Breast neoplasms, Radiation oncology, Postoperative complications, Neoplasm recurrence, local, Neoplasm metastasis, Disease-free survival
图1 乳腺癌腔镜手术切口示意图
图2 乳腺癌患者术后放射治疗靶区示意图　a～d图中蓝线范围分别代表胸壁野(乳房假体区域)、胸壁野＋内乳野、锁骨上野和腋窝照射野
表1 对照组与试验组乳腺癌患者临床资料比较
组别 例数 年龄(岁，±s) TNM分期(例) 腋窝淋巴结转移数目[枚，M(P25～P75)] ER(例) PR(例) HER-2(例)
Ⅱ期 Ⅲ期 阳性 阴性 阳性 阴性 阳性 阴性
对照组 56 38.9±7.4 33 23 2(2～4) 39 17 35 21 11 45
试验组 39 39.4±7.0 26 13 2(2～4) 32 7 29 10 8 31
检验值 ? t＝0.331 χ2＝0.585 Z＝0.085 χ2＝1.875 χ2＝1.471 χ2＝0.011
P值 ? 0.741 0.444 0.932 0.171 0.225 0.917
表2 对照组与试验组乳腺癌患者放射治疗区域比较(例)
组别 例数 胸壁野 锁骨上/下野 腋窝 内乳野
是 否 是 否 是 否 是 否
对照组 56 56 0 48 8 32 24 15 41
试验组 39 0 39 34 5 27 12 10 29
χ2值 ? 95.000 0.042 1.427 0.016
P值 ? <0.001 0.838 0.232 0.901
表3 对照组与试验组乳腺癌患者放射治疗相关并发症发生率比较(例)
组别 例数 放射性皮肤损伤 放射性肺炎 包膜挛缩 假体取出 并发症合计
是 否 是 否 是 否 是 否
对照组 56 5 51 2 54 5 51 2 54 12
试验组 39 1 38 0 39 0 39 0 39 1
χ2值 ? ? ? ? ? ? ? ? ? 6.926a
P值 ? 0.395 0.511 0.076 0.511 0.008
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