早期HER2过表达型乳腺癌术后放疗的作用

Role of postmastectomy radiotherapy in early HER2-enriched breast cancer

目的探讨T_(1~2)N_(1)M_(0)期人表皮生长因子受体-2(HER2)过表达型乳腺癌患者行改良根治术后放疗与否对局部控制和生存的影响,为指导临床决策提供参考。方法回顾性分析2000-01-22-2018-12-13接受改良根治术的277例T_(1~2)N_(1)M_(0)期HER2过表达型乳腺癌患者的临床资料,其中63例行术后放疗,214例未行放疗。采用Kaplan-Meier分析、多变量Cox比例风险法和倾向评分匹配比较2组患者的局部区域复发(LRR)、无病生存(DFS)和总生存(OS)。结果中位随访时间为56.7个月,277例患者中34例(12.3%)发生LRR。配对前放疗组5年LRR率(4.2%)低于未放疗组(16.2%),P=0.025;但2组5年DFS率(68.9%vs 75.5%,P=0.709)和5年OS率(91.4%vs 85.2%,P=0.358)差异无统计学意义。倾向评分匹配后,多因素分析显示放疗是LRR的独立预后因素,HR=0.120,95%CI为0.018~0.814,P=0.030。结论术后放疗可改善T_(1~2)N_(1)M_(0)期HER2过表达型乳腺癌的局部控制。

Objective To investigate the effect of postmastectomy radiotherapy(PMRT)on local control and survival in patients with stage T_(1-2)N_(1)M_(0)human epidermal growth factor receptor-2(HER2)-enriched breast cancer after modified radical mastectomy(MRM),and provide reference for clinical decision-making.Methods The clinical data of 277 patients with stage T_(1-2)N_(1)M_(0)HER2-enriched breast cancer who underwent MRM from January 22,2000 to December 13,2018 were analyzed retrospectively.Among them,63 patients received PMRT and 214 patients did not.The loco-regional recurrence(LRR),disease-free survival(DFS)and overall survival(OS)were compared between the two groups using the Kaplan-Meier analysis,multivariable Cox proportional hazards method,and propensity score matching.Results With median follow-up time of 56.7 months,34(12.3%)of 277 patients had experienced LRR.The 5-year LRR rate was lower in patients who received PMRT(4.2%)than in those who did not(16.2%),P=0.025,but there was no difference in 5-year DFS(before matching 68.9%vs 75.5%,P=0.709)and 5-year OS(before matching 91.4%vs.85.2%,P=0.358)between the two groups.After propensity score matching,multivariate analysis revealed that PMRT was an independent prognostic factor correlated with LRR(HR=0.120,95%CI:0.018-0.814,P=0.030).Conclusion PMRT could improve the local control of T_(1-2)N_(1)M_(0)HER2-enriched breast cancer.