乳腺癌根治术后局部区域性复发的放射治疗和预后影响因素

Radiotherapy for and prognosis of breast cancer patients with local-regional recurrence after mastectomy

背景与目的:局部和区域复发乳腺癌患者的治疗原则和预后因素仍存在一定争议。本研究旨在探讨乳腺癌术后胸壁和区域淋巴结复发患者放射治疗的疗效和影响生存率的预后因素。方法:回顾性分析复旦大学附属肿瘤医院1990-2005年收治的255例乳腺癌根治术或改良根治术后胸壁和区域淋巴结复发患者放射治疗后的生存和复发情况,并对影响生存的预后因素进行分析。结果:随访时间为9个月～15.5年,中位随访时间为45个月。首次治疗至复发的无病间期为2～260个月,中位时间为22个月,其中激素受体阳性者的中位无病间期时间为37个月,未知与阴性者为17个月。2年、5年和8年总生存率分别为86.4%、56.5%和35.0%,中位生存时间为79个月。2年、5年和8年局部控制率分别为56.1%,36.3%和27.6%。单因素检验分析发现、无病间期、复发部位、复发灶数目、激素受体状态、复发灶近期疗效是否达到完全缓解、原发灶T分期和腋窝淋巴结转移状态对生存率的影响有统计学意义(P值均<0.05)。多因素分析结果显示,无病间期、复发部位和数目及激素受体状态是独立的影响预后的因素。根据多因素分析结果建立预后指数,将全组患者划分为预后好、中等和差3个亚组,预后好组的2年、5年、8年总生存率分别为100%、91.6%、56.4%,预后中等组和预后差组分别为88.1%、59.1%、36.8%和68.0%、8.5%、0(P<0.001)。结论:放射治疗是乳腺癌根治术后局部和区域性复发有效的治疗手段。预后指数可以合理预测预后好、预后中等和预后差的患者。

Background and Objective：Controversies remain regarding the therapeutic principle for and prognosis of breast cancer patients with isolated local-regional recurrence after mastectomy. This study was to evaluate the rote of radiotherapy in treating these patients and to investigate the prognosis. Methods： Clinical data of 255 breast cancer patients with chest-wall and/or regional lymph node recurrence as first failure after mastectomy from 1990 to 2005 were analyzed. All patients received radiotherapy for recurrence. Results： The median follow-up time was 45 months （9 months-15.5 years）. The median disease-free interval （DFI） was 22 months （2-260 months）： it was 37 months in patients with positive hormonal receptor and 17 months in those with unknown or negative receptor. The 2-, 5-, and 8-year overall survival （OS） rates were 86.4%, 56.5%, and 35.0%, respectively. The median survival time was 79 months. The 2-, 5- and, 8-year local control rates were 6.1%, 36.3%, and 27.6%, respectively. Univariate prognostic analysis showed that DFI, site and number of recurrence, receptor status, short-term therapeutic response, initial T status and axillary involvement significantly affected the survival （all P〈0.05）; multivariate analysis showed that DFI, receptor status, site and number of recurrence were independent prognostic factors. Prognostic index was established to classify the patients. The 2-, 5- and 8-year OS rates were 100%, 91.6%, and 56.4% in the favorable prognosis group, 88.1%, 59.1%, and 36.8% in the medium prognosis group, 68.0%, 8.5%, and 0 in the poor prognosis group （P〈0.001）. Conclusion. Radiotherapy is effective for breast cancer patients with isolated local-regional recurrence after mastectomy. Prognostic index could be applied to predict the prognosis.