术后放疗在伴有腋窝淋巴结1～3枚阳性T2期乳腺癌中的作用

Value of Postmastectomy Radiotherapy in T_2 Breast Cancer Patients with 1-3 Positive Axillary Lymph Nodes

目的：探讨腋窝淋巴结1～3枚阳性的T2期乳腺癌根治术后是否需要接受放疗及放疗靶区的选择。方法：回顾性分析天津医科大学附属肿瘤医院1997年6月～1998年12月根治术后经病理证实腋窝淋巴结1-3枚阳性的T2期乳腺癌患者103例，其中44例未接受放疗，59例接受内乳区和锁骨上淋巴引流区放疗。所有患者术前腋窝均未触及肿大淋巴结，均未发现远处转移。分析患者的生存率、无瘤生存率、局部复发率及远处转移率。定量资料采用f检验，计数资料比较采用Χ^2检验，生存率计算采用Kaplan—Meier法，并用Log—rank检验。结果：未放疗组和放疗组的10年生存率分别为56．8％、72．9％（Χ^2=2．805，P=0．094），10年局部复发率分别为27．3％、10．2％（Χ^2=5．112，P=0．035），远处转移率分别为43.2％、22．0％（Χ^2=5．263，P=0．031），10年无瘤生存率分别为50．0％、64．4％（Χ^2=4．063，P=0．044）。两组患者胸壁复发率为7．8％。两组患者均未出现内乳淋巴引流区复发。内乳区放疗未能提高患者的生存率、降低局部复发率及远处转移率。结论：T2期乳腺癌根治术后腋窝淋巴结1～3枚阳性患者术后放疗降低了患者的局部复发率、远处转移率，提高了患者的生存率及无瘤生存率。内乳淋巴引流区复发少见，建议不给予内乳区放疗。建议T2期腋窝淋巴结1-3枚阳性乳腺癌患者根治术后给予胸壁及锁骨上区放疗。

Objective： To discuss whether T2 breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy need radiotherapy, and to determine the corresponding target region. Methods： We retrospectively analyzed 103 breast cancer patients treated in our hospital between 1997 and 1998. All patients underwent radical mastectomy. Of these patients, 44 did not receive irradiation, 59 received irradiation to the internal mammary chain and supraclavicular area. All patients had no intumescent axillary lymph nodes or distant metastasis before radical mastectomy. T-test was used to analyze quantitative data, and ANOVA was used to analyze numerical data. Kaplan-Meier method and Log rank test were employed to calculate and compare the survival rate. Results： The 10-year survival rate was 56.8% in the non-irradiation group and 72.9% in the irradiation group （Χ^2=2.805, P=0.094）. The 10-year disease free survival rate was 50.0% in the non-irradiation group and 64.4% in the irradiation group （Χ^2=4.063, P=0.044）. The 10-year local recurrence rate was 27.3% in the non-irradiation and 10.2% in the irradiation group （Χ^2=5.112, P=0.035）. The 10-year metastatic rate was 43.2% in the non-irradiation group and 22.0% in the irradiation group（Χ^2=5.263, P=0.031）. The 10-year chest wall recurrence rate in all patients was 7.8%. No patients had recurrence in the internal mammary chain area. Irradiation in the internal mammary chain area was useless and could not increase survival rate and disease free survival rate. Irradiation in the internal mammary chain area was not helpful for reducing local recurrence rate or distant metastatic rate. Conclusion： Radiation therapy can reduce local recurrence rate and metastatic rate in T2 breast cancer patients with one to three positive axillary lymph nodes, and can increase survival rate and disease free survival rate. Recurrence in the internal mammary chain area is rare. Therefore, it is not necessary to irradiate the internal mammary chain area. We suggest that T2 breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy should have irradiation to the chest wall and supraclavicular area.